Background

Meningococcal disease is a contagious bacterial infection caused by Neisseria meningitidis (N. meningitidis). Household contacts have the highest risk of contracting the disease during the first week of a case being detected. Prophylaxis is considered for those in close contact with people with a meningococcal infection and in populations with known high carriage rates.

Objectives

To study the effectiveness of different prophylactic treatment regimens.

Search methods

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2008, issue 4) which contains the Acute Respiratory Infections Group Specialised Register, MEDLINE (January 1966 to November 2008), EMBASE (1980 to November 2008) and LILACS (1982 to November 2008).

Selection criteria

Randomised controlled trials (RCTs) or quasi‐RCTs addressing the effectiveness of different antibiotic treatments for: (a) prophylaxis against meningococcal disease; (b) eradication of N. meningitidis.

Data collection and analysis

Two review authors independently appraised the quality of each trial and extracted data from the included trials. We analysed dichotomous data by calculating the relative risk (RR) and 95% confidence interval (CI) for each trial.

Main results

We included 24 studies; 19 including 2531 randomised participants and five including 4354 cluster‐randomised participants. There were no cases of meningococcal disease during follow up in any of the trials, thus effectiveness regarding prevention of future disease cannot be directly assessed.

Ciprofloxacin (RR 0.04; 95% CI 0.01 to 0.12), rifampin (rifampicin) (RR 0.17; 95% CI 0.13 to 0.24), minocycline (RR 0.28; 95% CI 0.21 to 0.37) and penicillin (RR 0.47; 95% CI 0.24 to 0.94) proved effective at eradicating N. meningitidis one week after treatment when compared with placebo. However, only rifampin (RR 0.20; 95% CI 0.14 to 0.29) and ciprofloxacin (RR 0.03; 95% CI 0.00 to 0.42) still proved effective at one to two weeks. Rifampin continued to be effective compared to placebo for up to four weeks after treatment but resistant isolates were seen following prophylactic treatment. No trials evaluated ceftriaxone against placebo but ceftriaxone was more effective than rifampin after one to two weeks of follow up (RR 5.93; 95% CI 1.22 to 28.68).

Authors' conclusions

Using rifampin during an outbreak may lead to the circulation of resistant isolates. Use of ciprofloxacin or ceftriaxone should be considered. Evidence suggests that all three agents are effective for up to two weeks follow up, though more trials comparing the effectiveness of these three agents for eradicating N. meningitidis would provide important insights.