Meningitis: intramuscular ceftriaxone cleared more meningococcal carriers than rifampicin

Clinical bottom line (level 1b)

  1. Contacts of patients with meningitidis who are carrying Neisseria meningitidis who received im ceftriaxone compared with rifamipicin were more likely to have eradication (NNT = 5 at 6 days) .
Schwartz et al: Lancet 1988; (8597): 1239-1242
Expires November 2003

The study

Unblinded ?concealed randomised trial without intention-to-treat
Setting: community, Saudi Arabia

116 patients (aged mean 24, 73% male) who were household contacts of confirmed cases of meningococcal meningitis, and found to have a positive nasal culture

Excluded if
  • received chemoprophylaxis


    • Control Group: (n = 41, 36 analysed): oral rifampicin 600 mg for adults or 10 mg/kg for children twice daily for 2 days
    Experimental Group: (n = 75, 68 analysed): intramuscular ceftriaxone 250 mg for adults or 125 mg for children aged < 15

    90% followed for 6 days

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    failure to eradicate N. meningitidis 6 days 9
    (25.0%)    		 2
    (2.94%)    		 88%
    (48% to 97%)    		 22.1%
    (7.35% to 36.8%)    		 5
    (3 to 14)

    Comments

    1. Patients were on a pilgrimage to Mecca and came from all over the world. Some of the differences reported may be due to cultural or language problems.

    Citation

    1. Schwartz B, Al-Tobaiqi A, Al-Ruwais A, et al: comparative efficacy of ceftriazone and rifampicin in eradicating pharyngeal carriage of group A Neisseria meningitidis. Lancet 1988; (8597): 1239-1242
    Contributor: Chris Ball and Clare Wotton, November 1999
    Reviewer:

    Clinical Question.
    Patient contacts of meningococcal meningitis
    Intervention or Exposure ceftriaxone
    Comparison rifampicin
    Outcome eradication