Ceftriaxone as effective as long-acting chloramphenicol in short-course treatment of meningococcal meningitis during epidemics: a randomised non-inferiority study.

Abstract

BACKGROUND:

In sub-Saharan Africa in the 1990s, more than 600,000 people had epidemic meningococcal meningitis, of whom 10% died. The current recommended treatment by WHO is short-course long-acting oily chloramphenicol. Continuation of the production of this drug is uncertain, so simple alternatives need to be found. We assessed whether the efficacy of single-dose treatment of ceftriaxone was non-inferior to that of oily chloramphenicol for epidemic meningococcal meningitis.

METHODS:

In 2003, we undertook a randomised, open-label, non-inferiority trial in nine health-care facilities in Niger. Participants with suspected disease who were older than 2 months were randomly assigned to receive either chloramphenicol or ceftriaxone. Primary outcome was treatment failure (defined as death or clinical failure) at 72 h, measured with intention-to-treat and per-protocol analyses.

FINDINGS:

Of 510 individuals with suspected disease, 247 received ceftriaxone, 256 received chloramphenicol, and seven were lost to follow-up. The treatment failure rate at 72 h for the intention-to-treat analysis was 9% (22 patients) for both drug groups (risk difference 0.3%, 90% CI -3.8 to 4.5). Case fatality rates and clinical failure rates were equivalent in both treatment groups (14 [6%] ceftriaxone vs 12 [5%] chloramphenicol). Results were also similar for both treatment groups in individuals with confirmed meningitis caused by Neisseria meningitidis. No adverse side-effects were reported.

INTERPRETATION:

Single-dose ceftriaxone provides an alternative treatment for epidemic meningococcal meningitis--its efficacy, ease of use, and low cost favour its use. National and international health partners should consider ceftriaxone as an alternative first-line treatment to chloramphenicol for epidemic meningococcal meningitis.

• Authors: N Nathan, T Borel, A Djibo, D Evans, S Djibo, J F Corty, M Guillerm, K P Alberti, L Pinoges, P J Guerin, D Legros
• Journal: Lancet (London, England) (Lancet) 2005 Jul 23-29 Vol. 366 Issue 9482 Pg. 308-13 ISSN: 1474-547X [Electronic] England
• PMID: 16039333 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial)

Chemical References

• Anti-Bacterial Agents
• Chloramphenicol
• Ceftriaxone

Topics

• Adolescent
• Anti-Bacterial Agents (administration & dosage)
• Ceftriaxone (administration & dosage)
• Child
• Child, Preschool
• Chloramphenicol (administration & dosage)
• Disease Outbreaks
• Female
• Humans
• Injections, Intramuscular
• Male
• Meningitis, Meningococcal (drug therapy, epidemiology, mortality)
• Niger (epidemiology)
• Survival Rate
• Treatment Failure