Coldiron ME, et al. - Authors evaluated the efficacy of single-dose oral ciprofloxacin administered to household contacts and in village-wide distributions on the overall attack rate (AR) in an outbreak of meningococcal meningitis. Overall meningitis AR was reduced by the village-wide distribution of single-dose oral ciprofloxacin within 72 hours of case notification. In future meningitis outbreak responses, distributions of ciprofloxacin could be an effective tool.

Methods

• Experts, in this 3-arm, open-label, cluster-randomized trial during a meningococcal meningitis outbreak in Madarounfa District, Niger, villages notifying a suspected case were randomly assigned (1:1:1) to standard care (the control arm), single-dose oral ciprofloxacin for household contacts within 24 hours of case notification, or village-wide distribution of ciprofloxacin within 72 hours of first case notification.
• The overall AR of suspected meningitis after inclusion was the primary outcome.
• They enrolled a random sample of 20 participating villages to document any changes in fecal carriage prevalence of ciprofloxacin-resistant and extended-spectrum beta-lactamase (ESBL)–producing Enterobacteriaceae before and after the intervention.
• They included 49 villeges between April 22 and May 18, 2017: 17 to the control arm, 17 to household prophylaxis, and 15 to village-wide prophylaxis.

Results

• As per the data, a total of 248 cases were notified in the study after the index cases.
• Findings suggested that the AR in the control arm was 451 per 100,000 persons, 386 per 100,000 persons in the household prophylaxis arm (t test vs control p= 0.68), and 190 per 100,000 persons in the village-wide prophylaxis arm (t test vs control p=0.032).
• Results demonstrated that the adjusted AR ratio between the household prophylaxis arm and the control arm was 0.94 (95% CI 0.52–1.73,p=0.85), and the adjusted AR ratio between the village-wide prophylaxis arm and the control arm was 0.40 (95% CI 0.19–0.87,p=0.022).
• They did not notified any adverse events.
• Data suggested that baseline carriage prevalence of ciprofloxacin-resistant Enterobacteriaceae was 95% and of ESBL-producing Enterobacteriaceae was >90%, and did not change post-intervention.
• Researchers found that the small number of cerebrospinal fluid samples sent for confirmatory testing was 1 limitation of the study.