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    Apr 11, 2021
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    Ceftriaxone as effective as long-acting chloramphenicol in short-course treatment of meningococcal meningitis during epidemics: a randomised non-inferiority study.

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    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
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    Affiliation
    Epicentre, Paris, France.
    Issue Date
    2008-04-14T12:02:10Z
    
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    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.
    Publisher
    Elsevier
    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
    ae974a485f413a2113503eed53cd6c53
    10.1016/S0140-6736(05)66792-X
    Scopus Count
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