A systematic review and meta-analysis of randomised controlled trials was performed in order to study the effectiveness of prophylactic treatment regimens in preventing secondary cases of
meningococcal disease (i.e., those contracted after contact with a person with
meningococcal disease) and in eradicating Neisseria meningitidis from the pharynx of healthy colonised individuals. The Medline, Embase, and Lilacs databases, the Cochrane Library, and the references of all studies identified were systematically searched for relevant trials. Two reviewers independently applied selection criteria, performed quality assessment, and selected data. Relative risks were pooled using a fixed effects model unless heterogeneity assessed by the I2 statistic and chi-square test was found. In such cases, a random effect model was used. There were no cases of
meningococcal disease following treatment with
antibiotics or placebo, thus effectiveness regarding prevention of future disease could not be directly assessed. Compared with placebo,
ciprofloxacin (RR = 0.04; 95%CI, 0.01-0.12),
rifampin (RR = 0.17; 95%CI, 0.12-0.24),
minocycline (RR = 0.30; 95%CI, 0.19-0.45), and
penicillin (RR = 0.47; 95%CI, 0.24-0.94), proved effective at eradicating Neisseria meningitidis 1 week
after treatment. After 1-2 weeks, only
ciprofloxacin (RR = 0.03; 95%CI, 0.00-0.42) and
rifampin (RR = 0.20; 95%CI, 0.14-0.29) still proved significantly effective when compared with placebo.
Rifampin continued to be effective (RR = 0.24; 95%CI, 0.16-0.37) compared with placebo until up to 4 weeks post treatment.
Rifampin was the only
drug to which resistance developed. Given that the use of
rifampin in an outbreak setting might lead to the circulation of isolates resistant to
rifampin, the use of
ciprofloxacin and
ceftriaxone should be considered.