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

Hdl Handle:
http://hdl.handle.net/10144/23232
Title:
Ceftriaxone as effective as long-acting chloramphenicol in short-course treatment of meningococcal meningitis during epidemics: a randomised non-inferiority study.
Authors:
Nathan, N; Borel, T; Djibo, A; Evans, D; Djibo, S; Corty, J F; Guillerm, M; Alberti, K P; Pinoges, L; Guerin, P J; Legros, D
Journal:
Lancet
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.
Affiliation:
Epicentre, Paris, France.
Publisher:
Elsevier
Issue Date:
14-Apr-2008
URI:
http://hdl.handle.net/10144/23232
DOI:
10.1016/S0140-6736(05)66792-X
PubMed ID:
16039333
Additional Links:
http://www.thelancet.com
Language:
en
ISSN:
1474-547X
Appears in Collections:
Other Diseases

Full metadata record

DC FieldValue Language
dc.contributor.authorNathan, N-
dc.contributor.authorBorel, T-
dc.contributor.authorDjibo, A-
dc.contributor.authorEvans, D-
dc.contributor.authorDjibo, S-
dc.contributor.authorCorty, J F-
dc.contributor.authorGuillerm, M-
dc.contributor.authorAlberti, K P-
dc.contributor.authorPinoges, L-
dc.contributor.authorGuerin, P J-
dc.contributor.authorLegros, D-
dc.date.accessioned2008-04-14T12:02:10Z-
dc.date.available2008-04-14T12:02:10Z-
dc.date.issued2008-04-14T12:02:10Z-
dc.identifier.citationCeftriaxone as effective as long-acting chloramphenicol in short-course treatment of meningococcal meningitis during epidemics: a randomised non-inferiority study., 366 (9482):308-13 Lanceten
dc.identifier.issn1474-547X-
dc.identifier.pmid16039333-
dc.identifier.doi10.1016/S0140-6736(05)66792-X-
dc.identifier.urihttp://hdl.handle.net/10144/23232-
dc.description.abstractBACKGROUND: 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.en
dc.language.isoenen
dc.publisherElsevieren
dc.relation.urlhttp://www.thelancet.comen
dc.rightsReproduced on this site with permission of Elsevier Ltd. Please see www.thelancet.com for further relevant comment.en
dc.subject.meshAdolescenten
dc.subject.meshAnti-Bacterial Agentsen
dc.subject.meshCeftriaxoneen
dc.subject.meshChilden
dc.subject.meshChild, Preschoolen
dc.subject.meshChloramphenicolen
dc.subject.meshDisease Outbreaksen
dc.subject.meshFemaleen
dc.subject.meshHumansen
dc.subject.meshInjections, Intramuscularen
dc.subject.meshMaleen
dc.subject.meshMeningitis, Meningococcalen
dc.subject.meshNigeren
dc.subject.meshSurvival Rateen
dc.subject.meshTreatment Failureen
dc.titleCeftriaxone as effective as long-acting chloramphenicol in short-course treatment of meningococcal meningitis during epidemics: a randomised non-inferiority study.en
dc.contributor.departmentEpicentre, Paris, France.en
dc.identifier.journalLanceten

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