Evaluation of single-dose ciprofloxacin in the eradication of Neisseria meningitidis from nasopharyngeal carriers

Abstract

The ability of a single oral 750-mg dose of ciprofloxacin to eradicate Neisseria meningiidis from persistent nasopharyngeal carriers was prospectively evaluated in a placebo-controlled, randomized, double-blinded study. Cultures of specimens taken from all 23 ciprofloxacin-dosed subjects 1 day postdose were negative; cultures from 96% of these subjects were negative at 7 and 21 days postdose, including a specimen from a subject colonized with a minocydine-resistant strain. Of 22 placebo recipients, 20 (91%) remained culture positive. Single-dose ciprofloxacin appears efficacious for meningococcal prophylaxis.Rifampin and minocycline are currently recommended prophylactic antimicrobial agents for Neisseria meningitidis infections. Although both drugs are effective, their use entails multidose regimens, as well as a risk of toxicity or occasional emergence ofresistance (7, 10). The carboxyquinolone ciprofloxacin has excellent in vitro activity against N. meningitidis (3). In previous placebo-controlled studies, multidose regimens of ciprofloxacin have been shown to be effective in eradicating N. meningitidis from chronic nasopharyngeal carriers up to 2 weeks after dosing (13). Furthermore, in an uncontrolled study, 11 of 12 N. meningitidis carriers given a single oral 750-mg dose of ciprofloxacin remained culture negative for 2 weeks after the dose (14). We report here the results of a placebo-controlled, randomized, double-blinded study of single-dose ciprofloxacin in persistent N. meningitidis carriers.Written informed consent was obtained from 620 healthy young volunteers, who were then evaluated for persistent nasopharyngeal carriage of N. meningitidis by means of two cultures taken 1 week apart, followed by a third culture taken 9 days later. Forty-six subjects whose cultures grew N. meningitidis on all three occasions were identified. These subjects provided a medical history and underwent a physical examination. They were tested for pregnancy by means of a qualitative test for human P-choriogonadotropin in urine; pregnant individuals were excluded from the trial. No subjects were allergic to quinolone drugs, had used antibiotics within 2 weeks of ciprofloxacin dosing, or had a symptomatic infection.Subjects were randomly assigned to take a single 750-mg oral dose of ciprofloxacin or a placebo tablet with an identical appearance. Nasopharyngeal cultures were taken 1, 7, and 21 days after dosing. All tablets were administered under supervision, and subjects were requested to report all adverse effects. At the time of the 7-day-postdose culture, a repeat physical examination was performed.Nasopharyngeal swabs were streaked onto modified Thayer-Martin agar and incubated at 37°C in 10% C02-90% air for 48 h. Colonies that resembled N. meningitidis were identified by Gram stain, positive oxidase reaction, and fermentation of glucose and maltose but not sucrose and lactose. Serogroups were determined by the slide agglutination technique with the cells suspended in physiological * Corresponding author.saline. Antise...

Use of quinolones in pediatrics

“…Additional potential indications for use of fluoroquinolones in pediatrics are epidemic bacillary dysentery due to Shigella (32), and eradication of carriage of the meningitic pathogens Neisseria meningitidis and HaemophiIus influenzae type b (33,34). However, to date no such trials performed in children have been published.…”

Prospects for Vaccine Prevention of Meningococcal Infection

“…In a study conducted by the Centers for Disease Control and Prevention (CDC), none of 693 household contacts of a meningococcal case who received appropriate chemoprophylaxis developed meningococcal disease, compared with 5 of 1,179 (0.424%) contacts who received no drugs or those felt to be ineffective (236,237). Chemoprophylactic agents that can be used to prevent secondary cases among adult contacts of patients with meningococcal infection include rifampin, single-dose intramuscular ceftriaxone, or single-dose oral ciprofloxacin; the first two agents can also be used in children (65,83,92,130,180,277,284,315,316,325). These agents generally decrease nasopharyngeal carriage by 90 to 95%.…”

Failures of Rifampicin and Ciprofloxacin to Eradicate a Susceptible Meningococcal Isolate from a Close Contact of a Fatal Case

“…It has been previously stated that rifampicin-resistant mutants of meningococci might persist in carriers after standard prophylactic administration of rifampicin [4][5][6]. There have also been rare reports of failure of ciprofloxacin and ceftriaxone in the eradication of N. meningitidis [7][8][9]. However, cases of rifampicin and ciprofloxacin-susceptible meningococci that persisted after prolonged prophylactic treatments with both regimens have not been documented before.…”