Meningococcal meningitis: prophylactic sulfadiazine reduced spread

Clinical bottom line (level 1c)

  1. Soldiers at risk of meningococcal meningitis who receive prophylactic sulfadiazine compared with no treatment were less likely to develop the disease (NNT = 500 at 8 weeks) .
Kuhns et al: Journal of the American Medical Association 1943; 123 ( 6 ): 335-339
Expires October 2003

The study

Case-control study with objective outcomes, not adjusted for confounding factors, not validated in an independent set of patients.
Setting: 2 US Army camps in separate sections

33800 patients (aged under 20, 100% male) at risk of developing meningococcal meningitis
Control Group: (n = 18800, 18800 analysed): no prophylactic treatment
Experimental Group: (n = 15000, 15000 analysed): prophylactic sulfadiazine 1 gm three times a day for 3 days or 1 gm twice daily for 2 days by mouth

100% followed for 8 weeks

The evidence

Outcome Time to outcome CER EER RRR
(95% CI)		 ARR
(95% CI)		 NNT
(95% CI)
meningococcal meningitis 8 weeks 40
(0.21%)		 2
(0.013%)		 94%
(74% to 98%)		 0.20%
(0.13% to 0.27%)		 500
(370 to 760)

Comments

  1. Weekly attack rates were 1.3 per 1000 for both groups prior to treatment.

Citation

  1. Kuhns DM, Nelson CT, Feldman HA, et al: the prophylactic value of sulfadiazine in the control of meningococcic meningitis. Journal of the American Medical Association 1943; 123 ( 6 ): 335-339
Search Terms: from Clinical Evidence volume 5
Contributor: Chris Ball, October 2001
Reviewer: Clare Wotton

Clinical Question.
Patient soldiers at risk of meningococcal meningitis
Intervention or Exposure sulfadiazine
Comparison no treatment
Outcome meningococcal meningitis