Pre-admission antibiotics for suspected cases of meningococcal disease

Abstract

Meningococcal disease is a contagious, bacterial disease caused by Neisseria meningitidis (N. meningitidis) that often leads rapidly to death. Administering antibiotics as soon as the condition is suspected, and while waiting for the diagnosis to be confirmed, has been advocated as a method of preventing death and the disabling consequences of this disease. We found no randomised controlled trials that compared pre-admission antibiotics with placebo or no intervention. In the one randomised controlled trial we identified, a single injection of either ceftriaxone (a relatively expensive, newer antibiotic) or a long-acting form of chloramphenicol (an inexpensive antibiotic) were found to be equally effective in preventing death and the disabling consequences in suspected, non-severe cases of meningococcal disease. Due to the serious complications of meningococcal disease, it would be difficult, for ethical reasons, to undertake randomised controlled trials comparing the use of antibiotics, as soon as the diagnosis is suspected, versus no antibiotics. However, further trials comparing different antibiotics in suspected meningococcal cases will provide insights that could help prevent death and the serious consequences of this disease