Meningitis: rifampicin cleared carriers more effectively than ciprofloxacin.

Clinical bottom line (level 1b)

  1. Carriers of meningococcus who took rifampicin compared with ciprofloxacin were more likely to have clearance (NNT = 13 at 6 days) .
  2. There was no clear difference between oral rifampicin and intramuscular ceftriaxone.
Cuevas et al: Journal of Infectious Disease 1995; 171: 728-731
Expires November 2003

The study

Double-blinded ?concealed randomised trial with intention-to-treat
Setting: community, Malawi

208 patients (aged ?, ?% male) who were close household contacts of patients with microbiologically confirmed meningococcal meningitis, and had nasopharyngeal meningococci
Control Group: (n = 88, 88 analysed): rifampicin 600 mg for adults, 20 mg/kg for children twice daily for 2 days
Experimental Group: (n = 79, 79 analysed): ciprofloxacin 750 mg for adults, 15 mg/kg for children as one dose
Experimental Group: (n = 41, 41 analysed): ceftriaxone 2g for pregnant or lactating women, 50 mg/kg for children aged < 2 as a single intramuscular injection

100% followed for 6 days

The evidence

ciprofloxacin v. rifampicin
Outcome Time to outcome CEREERRRR
(95% CI)		ARR
(95% CI)		NNT
(95% CI)
no eradication 6 days 3
(3.41%)		 9
(11.4%)		 -234%
(-1100% to 6%)		 -7.98%
(-16.0% to -0.02%)		 -13
(-5900 to -6)

ceftriaxone v. rifampicin
Outcome Time to outcome CEREERRRR
(95% CI)		ARR
(95% CI)		NNT
(95% CI)
no eradication 6 days 3
(3.41%)		 2
(4.88%)		 -43%
(-720% to 75%)		 -1.47%
(-9.07% to 6.14%)		 -68
(NNT = 16 to infinity;
NNH = 11 to infinity)

Comments

  1. No patients developed meningitis in the next 2 weeks.

Citation

  1. Cuevas LE, Kazembe P, Mughogho GK, et al: eradication of nasopharyngeal carriage of Neisseria meningitidis in children and adults in rural Africa: a comparison of ciprofloxacin and rifampicin. Journal of Infectious Disease 1995; 171: 728-731
Search Terms: meningi* in Cochrane
Contributor: Chris Ball and Clare Wotton, November 1999
Reviewer:

Clinical Question.
Patient household contacts of meningitis
Intervention or Exposure rifampicin
Comparison ciprofloxacin, ceftriaxone
Outcome eradication