BMJ  2004;328:1339 (5 June), doi:10.1136/bmj.328.7452.1339

Paper

Effectiveness of antibiotics in preventing meningococcal disease after a case: systematic review

Bernadette Purcell, specialist registrar1, Susanne Samuelsson, consultant epidemiologist2, Susan J M Hahné, European Programme for Intervention Epidemiology training fellow3, Ingrid Ehrhard, consultant microbiologist4, Sigrid Heuberger, consultant microbiologist5, Ivonne Camaroni, European Programme for Intervention Epidemiology training fellow3, André Charlett, head6, James M Stuart, consultant epidemiologist1

1 Communicable Disease Surveillance Centre South West, Gloucester GL10 3RF, 2 Statens Serum Institut, Copenhagen, Denmark 2300, 3 Communicable Disease Surveillance Centre, Cardiff, Wales CF4 3QX, 4 Landesuntersuchungsanstalt für das Gesundheits und Veterinärwesen, Dresden, Germany 01099, 5 National Reference Centre for Meningococci, Graz, Austria A-8010, 6 Public Health Laboratory Service Statistics Unit, Colindale, London NW9 5EQ

Correspondence to: J Stuart james.stuart{at}hpa.org.uk

Objective To summarise the evidence for the role of antibiotics in preventing further cases of meningococcal disease through chemoprophylaxis given to the index patient, household contacts, and children in day care settings after a single case.

Design Systematic review.

Methods Studies were identified by searching Embase (1983-2003), Medline (1965-2003), and CAB Health (1973-2003) and by contacting the World Health Organization and the European meningococcal disease surveillance network and examining references of identified papers. The review included all studies with at least 10 cases in which outcomes were compared between treated and untreated groups.

Main outcome measure Subsequent cases of meningococcal disease 1-30 days after onset of disease in the index patient.

Results Four observational studies and one small trial met the inclusion criteria. Meta-analysis of studies on chemoprophylaxis given to household contacts showed a significant reduction in risk (risk ratio 0.11, 95% confidence interval 0.02 to 0.58). The number needed to treat to prevent a case was estimated as 218 (121 to 1135). Primary outcome data were not available in studies of chemoprophylaxis given to the index patient: when prophylaxis had not been given, rate of carriage after discharge from hospital was estimated as 3% (0 to 6), probably an underestimate of the true rate. No studies of chemoprophylaxis in day care settings were identified that met the inclusion criteria.

Conclusion There have been no high quality experimental trials looking at control policies for meningococcal disease. The best available evidence is from retrospective studies. The risk of meningococcal disease in household contacts of a patient can be reduced by an estimated 89% if they take antibiotics known to eradicate meningococcal carriage. Chemoprophylaxis should be recommended for the index patient and all household contacts.


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