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<div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/Book"><div class="meta-content fm-sec"><div class="iconblock whole_rhythm clearfix no_top_margin"><a href="https://www.nice.org.uk" title="National Institute for Health and Care Excellence (NICE)" class="img_link icnblk_img" ref="pagearea=logo&targetsite=external&targetcat=link&targettype=publisher"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-niceng240er20-lrg.png" alt="Cover of Evidence review for antibiotics for bacterial meningitis caused by Neisseria meningitidis" /></a><div class="icnblk_cntnt"><h1 id="_NBK604080_"><span itemprop="name">Evidence review for antibiotics for bacterial meningitis caused by Neisseria meningitidis</span></h1><div class="subtitle">Meningitis (bacterial) and meningococcal disease: recognition, diagnosis and management</div><p><b>Evidence review E6</b></p><p><i>NICE Guideline, No. 240</i></p><div class="half_rhythm">London: <a href="https://www.nice.org.uk" ref="pagearea=meta&targetsite=external&targetcat=link&targettype=publisher"><span itemprop="publisher">National Institute for Health and Care Excellence (NICE)</span></a>; <span itemprop="datePublished">2024 Mar</span>.<div class="small">ISBN-13: <span itemprop="isbn">978-1-4731-5770-5</span></div></div><div><a href="/books/about/copyright/">Copyright</a> © NICE 2024.</div></div></div></div><div class="body-content whole_rhythm" itemprop="text"><div id="niceng240er20.s1"><h2 id="_niceng240er20_s1_">Antibiotics for bacterial meningitis caused by Neisseria meningitidis</h2><div id="niceng240er20.s1.1"><h3>Review question</h3><p>What antibiotic treatment regimens are effective in treating bacterial meningitis caused by Neisseria meningitidis?</p><div id="niceng240er20.s1.1.1"><h4>Introduction</h4><p>Bacterial meningitis is a rare but serious infection. The causative organism is usually confirmed by tests performed on cerebrospinal fluid or blood samples. Neisseria meningitidis is a common cause of bacterial meningitis in all age groups.</p><p>The aim of this review is to determine what antibiotic treatment regimens are effective in treating bacterial meningitis caused by Neisseria meningitidis.</p></div><div id="niceng240er20.s1.1.2"><h4>Summary of the protocol</h4><p>See <a href="/books/NBK604080/table/niceng240er20.tab1/?report=objectonly" target="object" rid-ob="figobniceng240er20tab1">Table 1</a> for a summary of the Population, Intervention, Comparison and Outcome (PICO) characteristics of this review.</p><p>For further details see the review protocol in <a href="#niceng240er20.appa">appendix A</a>.</p></div><div id="niceng240er20.s1.1.3"><h4>Methods and process</h4><p>This evidence review was developed using the methods and process described in <a href="https://www.nice.org.uk/process/pmg20/chapter/introduction" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual</a>. Methods specific to this review question are described in the review protocol in <a href="#niceng240er20.appa">appendix A</a> and the <a href="/books/NBK604080/bin/NG240-Methods-pdf.pdf">methods</a> document (supplementary document 1).</p><p>Declarations of interest were recorded according to <a href="https://www.nice.org.uk/about/who-we-are/policies-and-procedures" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NICE’s conflicts of interest policy</a>.</p></div><div id="niceng240er20.s1.1.4"><h4>Effectiveness evidence</h4><div id="niceng240er20.s1.1.4.1"><h5>Included studies</h5><p>Four studies were included for this review: 1 retrospective cohort study (<a class="bk_pop" href="#niceng240er20.s1.ref1">Isaacs 1988</a>), and 3 randomised controlled trials (RCTs: <a class="bk_pop" href="#niceng240er20.s1.ref2">Marhoum el Filali 1993</a>; <a class="bk_pop" href="#niceng240er20.s1.ref3">Molyneux 2011</a>; <a class="bk_pop" href="#niceng240er20.s1.ref4">Tuncer 1988</a>).</p><p>The included studies are summarised in <a href="/books/NBK604080/table/niceng240er20.tab2/?report=objectonly" target="object" rid-ob="figobniceng240er20tab2">Table 2</a>.</p><p>Two studies compared ceftriaxone to benzylpenicillin sodium (<a class="bk_pop" href="#niceng240er20.s1.ref2">Marhoum el Filali 1993</a>; <a class="bk_pop" href="#niceng240er20.s1.ref4">Tuncer 1988</a>). One study compared 5-day benzylpenicillin sodium therapy to >5-day benzylpenicillin sodium therapy (<a class="bk_pop" href="#niceng240er20.s1.ref1">Isaacs 1988</a>) and did not adjust for confounding factors. One study compared 5-day ceftriaxone therapy to 10-day ceftriaxone therapy (<a class="bk_pop" href="#niceng240er20.s1.ref3">Molyneux 2011</a>).</p><p>Two studies were conducted in babies and children (<a class="bk_pop" href="#niceng240er20.s1.ref3">Molyneux 2011</a>; <a class="bk_pop" href="#niceng240er20.s1.ref4">Tuncer 1988</a>), and 1 study was conducted in adults (<a class="bk_pop" href="#niceng240er20.s1.ref2">Marhoum el Filali 1993</a>). One study was conducted in both children and adults (<a class="bk_pop" href="#niceng240er20.s1.ref1">Isaacs 1988</a>).</p><p>See the literature search strategy in <a href="#niceng240er20.appb">appendix B</a> and study selection flow chart in <a href="#niceng240er20.appc">appendix C</a>.</p></div><div id="niceng240er20.s1.1.4.2"><h5>Excluded studies</h5><p>Studies not included in this review are listed, and reasons for their exclusion are provided in <a href="#niceng240er20.appj">appendix J</a>.</p></div></div><div id="niceng240er20.s1.1.5"><h4>Summary of included studies</h4><p>Summaries of the studies that were included in this review are presented in <a href="/books/NBK604080/table/niceng240er20.tab2/?report=objectonly" target="object" rid-ob="figobniceng240er20tab2">Table 2</a>.</p><p>See the full evidence tables in <a href="#niceng240er20.appd">appendix D</a>. No meta-analysis was conducted (and so there are no forest plots in <a href="#niceng240er20.appe">appendix E</a>).</p></div><div id="niceng240er20.s1.1.6"><h4>Summary of the evidence</h4><p>This section is a narrative summary of the findings of the review, as presented in the GRADE tables in <a href="#niceng240er20.appf">appendix F</a>. For details of the committee’s confidence in the evidence and how this affected recommendations, see <a href="#niceng240er20.s1.1.9">The committee’s discussion and interpretation of the evidence</a>.</p><p>The evidence was assessed as being very low quality due to risk of bias (arising from the randomisation process due to lack of information about allocation concealment, subjective measurement of the outcome, deviations from the intended interventions, missing outcome data and failure to adjust for confounding factors), seriously imprecise findings due to small number of events and the inclusion of indirect populations and outcomes. The evidence was stratified by age.</p><p>The evidence showed no important differences between ceftriaxone and benzylpenicillin sodium for mortality or cerebrospinal fluid (CSF) sterilisation in babies and children, or for mortality, neurological impairment, or CSF sterilisation in adults.</p><p>The evidence also showed no important differences between 5-day and 10-day ceftriaxone treatment for all-cause mortality, neurological impairment, developmental delay, hearing impairment, serious intervention-related adverse effects, or CSF sterilisation in babies and children.</p><p>Finally, the evidence showed no important differences between shorter (5-day) and longer (>5 day) durations of benzylpenicillin sodium therapy for mortality, neurological impairment, or hearing impairment in children and adults.</p><p>No eligible studies were identified that reported functional impairment, or intracranial collections as a complication (for example, abscess or empyema).</p><p>See <a href="#niceng240er20.appf">appendix F</a> for full GRADE tables.</p></div><div id="niceng240er20.s1.1.7"><h4>Economic evidence</h4><div id="niceng240er20.s1.1.7.1"><h5>Included studies</h5><p>A single economic search was undertaken for all topics included in the scope of this guideline, but no economic studies were identified which were applicable to this review question.</p></div></div><div id="niceng240er20.s1.1.8"><h4>Economic model</h4><p>No economic modelling was undertaken for this review because the committee agreed that other topics were higher priorities for economic evaluation.</p></div><div id="niceng240er20.s1.1.9"><h4>The committee’s discussion and interpretation of the evidence</h4><div id="niceng240er20.s1.1.9.1"><h5>The outcomes that matter most</h5><p>Bacterial meningitis is associated with high rates of mortality and morbidity, and antibiotics are the mainstay of treatment for bacterial meningitis. Therefore, all-cause mortality and long-term neurological impairment were prioritised as critical outcomes due to the severity of these outcomes. Severe developmental delay was prioritised over functional impairment in children and babies, as it is a more relevant and important outcome for this population. Functional impairment was prioritised as a critical outcome in adults due to the concern about the potential long-term limitations of bacterial meningitis on the ability to carry out certain activities of daily life.</p><p>In addition to functional impairment (in children and babies), hearing impairment, serious intervention-related adverse effects, and CSF sterilisation were selected as important outcomes in all age groups as these are relatively common after bacterial meningitis and may be related to antibiotic therapy. Intracranial collections as a complication was also included as an important outcome for adults as this is a rare but severe and life threatening complication of bacterial meningitis that may require prolonged antibiotic treatment.</p></div><div id="niceng240er20.s1.1.9.2"><h5>The quality of the evidence</h5><p>The quality of the evidence was assessed using GRADE methodology. The evidence for all outcomes identified in this review was very low quality, and the main reasons for downgrading the evidence were risk of bias (for example, arising from the randomisation process due to lack of information on allocation concealment, subjective measurement of the outcome, deviations from the intended interventions, missing outcome data due to attrition and failure to adjust for confounding factors), imprecision (due to wide confidence intervals and small number of events), and indirectness (of either population, outcome or both).</p><p>No evidence was found that reported functional impairment or intracranial collections as a complication.</p></div><div id="niceng240er20.s1.1.9.3"><h5>Benefits and harms</h5><p>The committee considered the evidence comparing ceftriaxone and benzylpenicillin sodium for the treatment of meningitis caused by Neisseria meningitidis (meningococcal meningitis), that showed no important differences for mortality, neurological impairment, or CSF sterilisation. However, the committee noted that this evidence came from 2 small and old RCTs. No other evidence was identified comparing the effectiveness of different antibiotics for the treatment of meningococcal meningitis. Given the limitations of the evidence, the committee agreed to make recommendations based on their clinical knowledge and experience, and on current practice, and recommended ceftriaxone in line with the BNF (<a class="bk_pop" href="#niceng240er20.s1.ref6">Joint Formulary Committee 2022</a>) and BNFC (<a class="bk_pop" href="#niceng240er20.s1.ref8">Paediatric Formulary Committee 2022</a>), for the treatment of meningococcal meningitis. The committee were aware that insufficient dose can increase the risk of treatment failure and antibiotic resistance; therefore, they agreed to use the maximum dose recommended by the BNF or BNFC or follow local antimicrobial guidance.</p><p>The committee highlighted the potential practical and resource-use advantages associated with ceftriaxone because the long half-life means that it can be given only once a day. The committee acknowledged some concerns with once daily administration in that a second dose might need to be delayed if the first dose of ceftriaxone was administered outside of routine working hours; however, they were aware that a second dose can be given earlier, to shift the administration time, if there is a minimum of 12 hours between doses (<a class="bk_pop" href="#niceng240er20.s1.ref5">Gbesemete 2019</a>).</p><p>The committee discussed some reasons why in clinical practice (particularly in intensive care units) cefotaxime might be given instead of ceftriaxone. For instance, to minimise the time that intravenous lines are being used for administering antibiotics, which might be needed for other medications, due to ceftriaxone typically being infused over 30 minutes intravenous and cefotaxime being given as a bolus. However, the committee agreed that this practice is not necessary, as ceftriaxone can be given as bolus. Sometimes there may be a reaction (for example, vomit reflex) if ceftriaxone is administered too quickly, but in the committee’s experience this is relatively rare, which was supported by a recent study (<a class="bk_pop" href="#niceng240er20.s1.ref9">Patel 2021</a>). The committee agreed that ceftriaxone should be given as first-line treatment for meningococcal meningitis, unless contraindicated in which case cefotaxime can be considered.</p><p>The committee were aware that the previous NICE guideline (<a class="bk_pop" href="#niceng240er20.s1.ref7">NICE 2010</a>) recommended 7-day antibiotic treatment for meningococcal meningitis. However, the committee noted that the evidence reviewed showed no important difference between 5 and 10 days of ceftriaxone therapy, although this study was unlikely to have been adequately powered to be taken as definitive evidence of equivalence. The committee acknowledged that practice has changed since the previous NICE guideline, and that the previous recommendations were consensus rather than evidence based and pre-dated the widespread use of cephalosporins. The committee discussed that, in some instances, practice has moved to shorter (5-day) courses of antibiotics for the treatment of meningococcal meningitis without apparent impact on clinical outcomes, although they acknowledged that there is variation in practice. Based on their clinical knowledge and experience, the committee agreed that meningococcus is more sensitive to antibiotics compared with other organisms, particularly cephalosporins such as ceftriaxone. The committee were also aware of evidence from low- and middle-income countries, suggesting that shorter length of treatment may be effective. The committee recommended that people with meningococcal meningitis should be treated for 5 days with ceftriaxone (or cefotaxime if ceftriaxone contraindicated). The committee agreed that advice from an infection specialist should be sought if the person had not recovered after 5 days.</p><p>There was no evidence found on antibiotic use for meningococcal meningitis in people with an antibiotic allergy, but the committee agreed it was important to make a recommendation for this population. Based on their knowledge and experience, the committee agreed that cephalosporin-induced anaphylaxis is rare, and the risk-benefit balance of a cephalosporin (relative to chloramphenicol as an alternative) is favourable in most patients with non-severe allergy. Therefore, the committee agreed that clinicians should seek information about the nature of the allergy and advice from an infection specialist (a microbiologist or infectious diseases specialist) before making a treatment decision, particularly for people who are pregnant. The committee acknowledged that it is important that treatment is not delayed; however, they agreed that information about the nature of allergy is often readily available from the patient’s family. The committee agreed that a cephalosporin should still be considered if the nature of the allergic reaction they get is not severe, in accordance with the first line treatment recommended above. However, if the allergic reaction is severe, alternatives to ceftriaxone or cefotaxime will be needed. The committee discussed that chloramphenicol is commonly used in the case of severe beta-lactam (penicillin, amoxicillin, or cephalosporin) allergy. Based on clinical knowledge and experience, the committee recommended chloramphenicol for people with meningococcal meningitis and severe antibiotic allergy.</p><p>The committee were aware that the previous NICE guideline on bacterial meningitis (<a class="bk_pop" href="#niceng240er20.s1.ref7">NICE 2010</a>) recommended to treat people who have travelled outside the UK with vancomycin (in addition to the cephalosporin). However, they discussed that practice has changed since the previous NICE guideline. The committee were aware that current practice is to use rifampicin or linezolid in addition to a cephalosporin where the cephalosporin itself might be insufficient due to resistance. However, the committee highlighted that there is not enough evidence to support recommending them. Therefore, the committee recommended that clinicians should seek advice from an infection specialist for all cases of bacterial meningitis, but this was particularly important if cephalosporin resistance is suspected in people who have recently travelled abroad.</p></div><div id="niceng240er20.s1.1.9.4"><h5>Cost effectiveness and resource use</h5><p>This review question was not prioritised for economic analysis and therefore the committee made a qualitative assessment of the likely cost-effectiveness of their recommendations. The committee considered that it would be cost-effective to facilitate the option of a shorter course of antibiotics than in previous NICE guidance (<a class="bk_pop" href="#niceng240er20.s1.ref7">NICE 2010</a>) for meningococcal meningitis as some practice has moved in this direction without any apparent adverse impact on clinical outcomes. However, given the absence of evidence supporting shorter courses in developed countries they did not want to mandate this. The committee believed that by facilitating the option of a shorter course of antibiotics that their recommendation could lead to some small cost savings for the NHS.</p></div></div><div id="niceng240er20.s1.1.10"><h4>Recommendations supported by this evidence review</h4><p>This evidence review supports recommendations 1.6.4, 1.6.15, and 1.6.16. Other evidence supporting the recommendations 1.6.4 and 1.6.16 can be found in evidence reviews on antibiotic regimens for bacterial meningitis before or in the absence of identifying causative infecting organism (see evidence reviews D1 to D3) and for specific causative organisms (see evidence reviews E1 to E5).</p></div></div><div id="niceng240er20.s1.rl.r1"><h3>References – included studies</h3><ul class="simple-list"><div id="niceng240er20.s1.rl.r1.1"><h4>Effectiveness</h4><ul class="simple-list"><li class="half_rhythm"><div class="bk_ref" id="niceng240er20.s1.ref1"><p id="p-130">
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<strong>Isaacs 1988</strong>
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</p>Isaacs, R. D., Howden, C. W., Lang, W. R.
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et al. (1988) Short course chemotherapy for meningococcal meningitis. Australian and New Zealand journal of medicine
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18(5): 731–2
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[<a href="https://pubmed.ncbi.nlm.nih.gov/3245827" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 3245827</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="niceng240er20.s1.ref2"><p id="p-131">
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<strong>Marhoum el Filali 1993</strong>
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</p>Marhoum el Filali, K., Noun, M., Chakib, A.
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et al. (1993) Ceftriaxone versus penicillin G in the short-term treatment of meningococcal meningitis in adults. European journal of clinical microbiology & infectious diseases
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12(10): 766–768
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[<a href="https://pubmed.ncbi.nlm.nih.gov/8307046" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8307046</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="niceng240er20.s1.ref3"><p id="p-132">
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<strong>Molyneux 2011</strong>
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</p>Molyneux, Elizabeth, Nizami, Shaikh Qamaruddin, Saha, Samir
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||
et al. (2011) 5 versus 10 days of treatment with ceftriaxone for bacterial meningitis in children: a double-blind randomised equivalence study. Lancet (London, England) 377(9780): 1837–45
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||
[<a href="https://pubmed.ncbi.nlm.nih.gov/21620467" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21620467</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="niceng240er20.s1.ref4"><p id="p-133">
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<strong>Tuncer 1988</strong>
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</p>Tuncer, A. M., Gür, I., Ertem, U.
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et al. (1988) Once daily ceftriaxone for meningococcemia and meningococcal meningitis. Pediatric infectious disease journal
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7(10): 711–713
|
||
[<a href="https://pubmed.ncbi.nlm.nih.gov/3054778" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 3054778</span></a>]</div></li></ul></div><div id="niceng240er20.s1.rl.r1.2"><h4>Economic</h4><ul class="simple-list"><p>No studies were identified which were applicable to this review question.</p></ul></div><div id="niceng240er20.s1.rl.r1.3"><h4>Other</h4><ul class="simple-list"><li class="half_rhythm"><div class="bk_ref" id="niceng240er20.s1.ref5"><p id="p-135">
|
||
<strong>Gbesemete 2019</strong>
|
||
</p>Gbesemete, D., Faust, S. (2019). Prescribing in infection: antibacterials. In. Barker, C., Turner, M., Sharland, M. (Eds.) Prescribing Medicines for Children: From drug development to practical administration, Pharmaceutical Press, London: UK</div></li><li class="half_rhythm"><div class="bk_ref" id="niceng240er20.s1.ref6"><p id="p-136">
|
||
<strong>Joint Formulary Committee 2022</strong>
|
||
</p>Joint Formulary Committee. British National Formulary (online). London: BMJ Group and Pharmaceutical Press. Available at: <a href="http://www.medicinescomplete.com" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">http://www<wbr style="display:inline-block"></wbr>.medicinescomplete.com</a> [Accessed 04/04/2022]</div></li><li class="half_rhythm"><div class="bk_ref" id="niceng240er20.s1.ref7"><p id="p-137">
|
||
<strong>NICE 2010</strong>
|
||
</p>National Institute for Health and Care Excellence (2010). Meningitis (bacterial) and meningococcal septicaemia in under 16s: recognition, diagnosis and management. Available at: <a href="https://www.nice.org.uk/guidance/cg102" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">https://www<wbr style="display:inline-block"></wbr>.nice.org.uk/guidance/cg102</a> [Accessed 04/04/2022] [<a href="https://pubmed.ncbi.nlm.nih.gov/32207890" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32207890</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="niceng240er20.s1.ref8"><p id="p-138">
|
||
<strong>Paediatric Formulary Committee 2022</strong>
|
||
</p>Paediatric Formulary Committee. BNF for Children (online). London: BMJ Group, Pharmaceutical Press, and RCPCH Publications. Available at: <a href="http://www.medicinescomplete.com" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">http://www<wbr style="display:inline-block"></wbr>.medicinescomplete.com</a> [Accessed 29/03/2022]</div></li><li class="half_rhythm"><div class="bk_ref" id="niceng240er20.s1.ref9"><p id="p-139">
|
||
<strong>Patel 2021</strong>
|
||
</p>Patel, S., Green. H., Gray, J., Rutter, M., Bevan, A., Hand, K., Jones, C. E., Faust, S. N. (2021). Evaluating Ceftriaxone 80 mg/kg Administration by Rapid Intravenous Infusion—A Clinical Service Evaluation. The Pediatric Infectious Disease Journal, 40(2), 128–129
|
||
[<a href="https://pubmed.ncbi.nlm.nih.gov/33165272" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33165272</span></a>]</div></li></ul></div></ul></div></div><div id="appendixesappgroup1"><h2 id="_appendixesappgroup1_">Appendices</h2><div id="niceng240er20.appa"><h3>Appendix A. Review protocols</h3><p id="niceng240er20.appa.et1"><a href="/books/NBK604080/bin/niceng240er20-appa-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Review protocol for review question: What antibiotic treatment regimens are effective in treating bacterial meningitis caused by Neisseria meningitidis?</a><span class="small"> (PDF, 263K)</span></p></div><div id="niceng240er20.appb"><h3>Appendix B. Literature search strategies</h3><p id="niceng240er20.appb.et1"><a href="/books/NBK604080/bin/niceng240er20-appb-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Literature search strategies for review question: What antibiotic treatment regimens are effective in treating bacterial meningitis caused by Neisseria meningitidis?</a><span class="small"> (PDF, 221K)</span></p></div><div id="niceng240er20.appc"><h3>Appendix C. Effectiveness evidence study selection</h3><p id="niceng240er20.appc.et1"><a href="/books/NBK604080/bin/niceng240er20-appc-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Study selection for: What antibiotic treatment regimens are effective in treating bacterial meningitis caused by Neisseria meningitidis?</a><span class="small"> (PDF, 198K)</span></p></div><div id="niceng240er20.appd"><h3>Appendix D. Evidence tables</h3><p id="niceng240er20.appd.et1"><a href="/books/NBK604080/bin/niceng240er20-appd-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Evidence tables for review question: What antibiotic treatment regimens are effective in treating bacterial meningitis caused by Neisseria meningitidis?</a><span class="small"> (PDF, 246K)</span></p></div><div id="niceng240er20.appe"><h3>Appendix E. Forest plots</h3><div id="niceng240er20.appe.s1"><h4>Forest plots for review question: What antibiotic treatment regimens are effective in treating bacterial meningitis caused by Neisseria meningitidis?</h4><p>No meta-analysis was conducted for this review question and so there are no forest plots.</p></div></div><div id="niceng240er20.appf"><h3>Appendix F. GRADE tables</h3><p id="niceng240er20.appf.et1"><a href="/books/NBK604080/bin/niceng240er20-appf-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">GRADE tables for review question: What antibiotic treatment regimens are effective in treating bacterial meningitis caused by Neisseria meningitidis?</a><span class="small"> (PDF, 184K)</span></p></div><div id="niceng240er20.appg"><h3>Appendix G. Economic evidence study selection</h3><p id="niceng240er20.appg.et1"><a href="/books/NBK604080/bin/niceng240er20-appg-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Study selection for: What antibiotic treatment regimens are effective in treating bacterial meningitis caused by Neisseria meningitidis?</a><span class="small"> (PDF, 106K)</span></p></div><div id="niceng240er20.apph"><h3>Appendix H. Economic evidence tables</h3><div id="niceng240er20.apph.s1"><h4>Economic evidence tables for review question: What antibiotic treatment regimens are effective in treating bacterial meningitis caused by Neisseria meningitidis?</h4><p>No evidence was identified which was applicable to this review question.</p></div></div><div id="niceng240er20.appi"><h3>Appendix I. Economic model</h3><div id="niceng240er20.appi.s1"><h4>Economic model for review question: What antibiotic treatment regimens are effective in treating bacterial meningitis caused by Neisseria meningitidis?</h4><p>No economic analysis was conducted for this review question.</p></div></div><div id="niceng240er20.appj"><h3>Appendix J. Excluded studies</h3><div id="niceng240er20.appj.s1"><h4>Excluded studies for review question: What antibiotic treatment regimens are effective in treating bacterial meningitis caused by Neisseria meningitidis?</h4></div><div id="niceng240er20.appj.s2"><h4>Excluded effectiveness studies</h4><p>The excluded studies table only lists the studies that were considered and then excluded at the full-text stage for this review (N=9) and not studies (N=179) that were considered and then excluded from the search at the full-text stage as per the PRISMA diagram in <a href="#niceng240er20.appc">Appendix C</a> for the other review questions in the same search.</p><div id="niceng240er20.appj.tab1" class="table"><h3><span class="label">Table 9</span><span class="title">Excluded studies and reasons for their exclusion</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK604080/table/niceng240er20.appj.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng240er20.appj.tab1_lrgtbl__"><table><thead><tr><th id="hd_h_niceng240er20.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study</th><th id="hd_h_niceng240er20.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Code [Reason]</th></tr></thead><tbody><tr><td headers="hd_h_niceng240er20.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Boisivon, A., Berardi-Grassias, L., Guiomar, C.
|
||
et al. (1987) Bacteriostatic and bactericidal effect of ceftriaxone on Hemophilus, Neisseria meningitidis, and Proteus. Chemioterapia : international journal of the Mediterranean Society of Chemotherapy
|
||
6(2suppl): 83–84
|
||
|
||
[<a href="https://pubmed.ncbi.nlm.nih.gov/3151360" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 3151360</span></a>]
|
||
</td><td headers="hd_h_niceng240er20.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- No comparison of interest</td></tr><tr><td headers="hd_h_niceng240er20.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Congeni, B. L. (1984) Comparison of ceftriaxone and traditional therapy of bacterial meningitis. Antimicrobial agents and chemotherapy
|
||
25(1): 40–44
|
||
[<a href="/pmc/articles/PMC185431/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC185431</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/6322681" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 6322681</span></a>]
|
||
</td><td headers="hd_h_niceng240er20.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Population does not meet inclusion criteria</td></tr><tr><td headers="hd_h_niceng240er20.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Crosswell, Julie M.; Nicholson, W. Ross; Lennon, Diana R. (2006) Rapid sterilisation of cerebrospinal fluid in meningococcal meningitis: Implications for treatment duration. Journal of paediatrics and child health
|
||
42(4): 170–3
|
||
[<a href="https://pubmed.ncbi.nlm.nih.gov/16630316" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16630316</span></a>]
|
||
</td><td headers="hd_h_niceng240er20.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- No comparison of interest</td></tr><tr><td headers="hd_h_niceng240er20.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Goldwater, Paul N. (2005) Cefotaxime and ceftriaxone cerebrospinal fluid levels during treatment of bacterial meningitis in children. International journal of antimicrobial agents
|
||
26(5): 408–11
|
||
[<a href="https://pubmed.ncbi.nlm.nih.gov/16216469" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16216469</span></a>]
|
||
</td><td headers="hd_h_niceng240er20.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- No outcomes of interest</td></tr><tr><td headers="hd_h_niceng240er20.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Hussein, A. A. and Abdel Rahman, S. I. (2003) Meningococcal meningitis epidemic: A new role for single-dose oily chloramphenicol. Neurosciences
|
||
7(3): 171–175 [<a href="https://pubmed.ncbi.nlm.nih.gov/23978966" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23978966</span></a>]
|
||
</td><td headers="hd_h_niceng240er20.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Cohort study from low income country</td></tr><tr><td headers="hd_h_niceng240er20.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Nathan, N., Borel, T., Djibo, A.
|
||
et al. (2005) Ceftriaxone as effective as long-acting chloramphenicol in short-course treatment of meningococcal meningitis during epidemics: a randomised non-inferiority study. Lancet (London, England) 366(9482): 308–13
|
||
[<a href="https://pubmed.ncbi.nlm.nih.gov/16039333" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16039333</span></a>]
|
||
</td><td headers="hd_h_niceng240er20.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Population does not meet inclusion criteria</td></tr><tr><td headers="hd_h_niceng240er20.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Peltola, H.; Anttila, M.; Renkonen, O. V. (1989) Randomised comparison of chloramphenicol, ampicillin, cefotaxime, and ceftriaxone for childhood bacterial meningitis. Finnish Study Group. Lancet (london, england) 1(8650): 1281–1287
|
||
[<a href="https://pubmed.ncbi.nlm.nih.gov/2566824" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2566824</span></a>]
|
||
</td><td headers="hd_h_niceng240er20.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Population does not meet inclusion criteria</td></tr><tr><td headers="hd_h_niceng240er20.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Roine, I., Ledermann, W., Foncea, L. M.
|
||
et al. (2000) Randomized trial of four vs. seven days of ceftriaxone treatment for bacterial meningitis in children with rapid initial recovery. Pediatric infectious disease journal
|
||
19(3): 219–222
|
||
[<a href="https://pubmed.ncbi.nlm.nih.gov/10749463" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10749463</span></a>]
|
||
</td><td headers="hd_h_niceng240er20.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Population does not meet inclusion criteria</td></tr><tr><td headers="hd_h_niceng240er20.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Singhi, P., Kaushal, M., Singhi, S.
|
||
et al. (2002) Seven days vs. 10 days ceftriaxone therapy in bacterial meningitis. Journal of tropical pediatrics
|
||
48(5): 273–279
|
||
[<a href="https://pubmed.ncbi.nlm.nih.gov/12405169" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12405169</span></a>]
|
||
</td><td headers="hd_h_niceng240er20.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Population does not meet inclusion criteria</td></tr></tbody></table></div></div></div><div id="niceng240er20.appj.s3"><h4>Excluded economic studies</h4><p>No studies were identified which were applicable to this review question.</p></div></div><div id="niceng240er20.appk"><h3>Appendix K. Research recommendations – full details</h3><div id="niceng240er20.appk.s1"><h4>Research recommendations for review question: What antibiotic treatment regimens are effective in treating bacterial meningitis caused by Neisseria meningitidis?</h4><p>No research recommendation was made for this review.</p></div></div></div><div class="bk_prnt_sctn"><h2>Tables</h2><div class="whole_rhythm bk_prnt_obj bk_first_prnt_obj"><div id="niceng240er20.tab1" class="table"><h3><span class="label">Table 1</span><span class="title">Summary of the protocol (PICO table)</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK604080/table/niceng240er20.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng240er20.tab1_lrgtbl__"><table class="no_bottom_margin"><tbody><tr><th id="hd_b_niceng240er20.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><td headers="hd_b_niceng240er20.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">All adults, young people, children and babies (excluding neonates defined as aged 28 days old and younger) with confirmed bacterial meningitis caused by Neisseria meningitidis</td></tr><tr><th id="hd_b_niceng240er20.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intervention</th><td headers="hd_b_niceng240er20.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Antibiotic agent of interest:
|
||
<ul><li class="half_rhythm"><div>Cefotaxime</div></li><li class="half_rhythm"><div>Ceftriaxone</div></li><li class="half_rhythm"><div>Benzylpencillin sodium</div></li><li class="half_rhythm"><div>Amoxicillin</div></li><li class="half_rhythm"><div>Ampicillin</div></li><li class="half_rhythm"><div>Ciprofloxacin</div></li><li class="half_rhythm"><div>Moxifloxacin</div></li><li class="half_rhythm"><div>Levofloxacin</div></li><li class="half_rhythm"><div>Chloramphenicol</div></li><li class="half_rhythm"><div>Meropenem</div></li></ul></td></tr><tr><th id="hd_b_niceng240er20.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparison</th><td headers="hd_b_niceng240er20.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><b>Stage 1 (all antibiotic agents of interest):</b>
|
||
<ul><li class="half_rhythm"><div>Antibiotic agent A (single or combination) vs Antibiotic agent B (single or combination)</div></li></ul>
|
||
<b>Stage 2 (antibiotic agents identified during stage 1 as most effective/for use where there are contraindications)</b>
|
||
<ul><li class="half_rhythm"><div>Antibiotic agent A – Dose A vs Antibiotic agent A – Dose B</div></li><li class="half_rhythm"><div>Antibiotic agent A – Duration of administration A vs Antibiotic agent A – Duration of administration B</div></li><li class="half_rhythm"><div>Antibiotic agent A – Short infusion vs Antibiotic agent A – Extended infusion</div></li></ul></td></tr><tr><th id="hd_b_niceng240er20.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcome</th><td headers="hd_b_niceng240er20.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>
|
||
<b>Critical</b>
|
||
</p>
|
||
<p>Population: adults, children and infants
|
||
<ul><li class="half_rhythm"><div>All-cause mortality (measured up to 1 year after discharge)</div></li><li class="half_rhythm"><div>Any long-term neurological impairment (defined as any motor deficits, sensory deficits [excluding hearing impairment], cognitive deficits*, or behavioural deficits*; measured from discharge up to 1 year after discharge)</div></li></ul>
|
||
Population: adults
|
||
<ul><li class="half_rhythm"><div>Functional impairment (measured by any validated scale at any time point)</div></li></ul>
|
||
Population: children and infants
|
||
<ul><li class="half_rhythm"><div>Severe developmental delay (defined as score of >2 SD below normal on validated assessment scales, or MDI or PDI <70 on Bayleys assessment scale, or inability to assign a score due to cerebral palsy or severity of cognitive delay; measured at the oldest age reported unless there is substantially more data available at a younger age)</div></li></ul>
|
||
<b>Important</b></p>
|
||
<p>Population: adults, children and infants
|
||
<ul><li class="half_rhythm"><div>Hearing impairment (defined as any level of hearing impairment; measured from discharge up to 1 year after discharge)</div></li><li class="half_rhythm"><div>Serious intervention-related adverse effects leading to death, disability or prolonged hospitalisation or that are life threatening or otherwise considered medically significant</div></li><li class="half_rhythm"><div>CSF sterilisation (defined as treatment failure, time-to-sterilisation or delay).</div></li></ul>
|
||
Population: adults
|
||
<ul><li class="half_rhythm"><div>Intracranial collections as a complication (defined as abscess or empyema)</div></li></ul>
|
||
Population: children and infants
|
||
<ul><li class="half_rhythm"><div>Functional impairment (measured by any validated scale at any time point)</div></li></ul>
|
||
*For infants and children below school-age, cognitive and behavioural deficits will be assessed at school-age.</p>
|
||
</td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt></dt><dd><div><p class="no_margin">CSF: cerebrospinal fluid; MDI: mental development index; PDI: psychomotor development index; SD: standard deviation</p></div></dd></dl></div></div></div></div><div class="whole_rhythm bk_prnt_obj"><div id="niceng240er20.tab2" class="table"><h3><span class="label">Table 2</span><span class="title">Summary of included studies</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK604080/table/niceng240er20.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng240er20.tab2_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng240er20.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study</th><th id="hd_h_niceng240er20.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><th id="hd_h_niceng240er20.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intervention</th><th id="hd_h_niceng240er20.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparison</th><th id="hd_h_niceng240er20.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcomes</th><th id="hd_h_niceng240er20.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comments</th></tr></thead><tbody><tr><td headers="hd_h_niceng240er20.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>
|
||
<a class="bk_pop" href="#niceng240er20.s1.ref1">Isaacs 1988</a>
|
||
</p>
|
||
<p>Retrospective cohort study</p>
|
||
<p>New Zealand</p>
|
||
</td><td headers="hd_h_niceng240er20.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>N=35</p>
|
||
<p>Patients aged ≥14 years with meningitis caused by N. meningitidis</p>
|
||
<p>Age in years (mean; SD): 28 (14)</p>
|
||
<p>Case-fatality: 0%</p>
|
||
</td><td headers="hd_h_niceng240er20.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>
|
||
<u>5-day benzylpenicillin sodium therapy</u>
|
||
</p>
|
||
<p>IV benzylpenicillin sodium for 5 days</p>
|
||
</td><td headers="hd_h_niceng240er20.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>
|
||
<u>>5-day benzylpenicillin sodium therapy</u>
|
||
</p>
|
||
<p>IV benzylpenicillin sodium for average duration of 8.5 days</p>
|
||
</td><td headers="hd_h_niceng240er20.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<ul><li class="half_rhythm"><div>All-cause mortality</div></li><li class="half_rhythm"><div>Any long-term neurological impairment</div></li><li class="half_rhythm"><div>Hearing impairment</div></li></ul></td><td headers="hd_h_niceng240er20.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Frequency and dose of medication were not described.</td></tr><tr><td headers="hd_h_niceng240er20.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>
|
||
<a class="bk_pop" href="#niceng240er20.s1.ref2">Marhoum el Filali 1993</a>
|
||
</p>
|
||
<p>RCT</p>
|
||
<p>Morocco</p>
|
||
</td><td headers="hd_h_niceng240er20.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>N=36</p>
|
||
<p>Adults aged >16 years with meningitis caused by N. meningitidis</p>
|
||
<p>Age in years (mean; SD): 29 (14)</p>
|
||
<p>Case-fatality: 6%</p>
|
||
</td><td headers="hd_h_niceng240er20.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>
|
||
<u>Ceftriaxone</u>
|
||
</p>
|
||
<p>IV ceftriaxone 2g once daily for 2 days</p>
|
||
</td><td headers="hd_h_niceng240er20.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>
|
||
<u>Benzylpenicillin sodium</u>
|
||
</p>
|
||
<p>IV penicillin G 300,000 IU/kg/day every 4 hours for 6 days</p>
|
||
</td><td headers="hd_h_niceng240er20.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<ul><li class="half_rhythm"><div>All-cause mortality</div></li><li class="half_rhythm"><div>Any long-term neurological impairment</div></li><li class="half_rhythm"><div>CSF sterilisation</div></li></ul></td><td headers="hd_h_niceng240er20.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population is indirect due to 28% of population with unknown cause of meningitis</td></tr><tr><td headers="hd_h_niceng240er20.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>
|
||
<a class="bk_pop" href="#niceng240er20.s1.ref3">Molyneux 2011</a>
|
||
</p>
|
||
<p>RCT</p>
|
||
<p>Bangladesh, Egypt, Malawi, Pakistan and Vietnam</p>
|
||
</td><td headers="hd_h_niceng240er20.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>N. meningitidis N=73 (whole study N=1004)</p>
|
||
<p>Babies and children aged 2 months to 12 years with meningitis caused by H. influenzae, S. pneumoniae, or N. meningitidis*</p>
|
||
<p>Age in months (mean; SD): 38 (42)</p>
|
||
<p>Case-fatality: 4%</p>
|
||
<p>*N. meningitidis is causative organism of interest for this review</p>
|
||
</td><td headers="hd_h_niceng240er20.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>
|
||
<u>5-day ceftriaxone therapy</u>
|
||
</p>
|
||
<p>IV ceftriaxone 80-100 mg/kg once daily for 5 days</p>
|
||
</td><td headers="hd_h_niceng240er20.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>
|
||
<u>10-day ceftriaxone therapy</u>
|
||
</p>
|
||
<p>IV ceftriaxone 80-100 mg/kg once daily for 10 days</p>
|
||
</td><td headers="hd_h_niceng240er20.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<ul><li class="half_rhythm"><div>All-cause mortality</div></li><li class="half_rhythm"><div>Any long-term neurological impairment</div></li><li class="half_rhythm"><div>Developmental delay</div></li><li class="half_rhythm"><div>Hearing impairment</div></li><li class="half_rhythm"><div>Serious intervention-related adverse effects</div></li><li class="half_rhythm"><div>CSF sterilisation</div></li></ul></td><td headers="hd_h_niceng240er20.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population is indirect for all outcomes except for all-cause mortality and CSF sterilisation due to 93% of population with meningitis caused by organisms other than N. meningitidis</td></tr><tr><td headers="hd_h_niceng240er20.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>
|
||
<a class="bk_pop" href="#niceng240er20.s1.ref4">Tuncer 1988</a>
|
||
</p>
|
||
<p>RCT</p>
|
||
<p>Turkey</p>
|
||
</td><td headers="hd_h_niceng240er20.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>N=42</p>
|
||
<p>Babies and children aged 1 month to 12 years with N. meningitidis infection</p>
|
||
<p>Age (range): 1 month to 12 years</p>
|
||
<p>Case-fatality: 7%</p>
|
||
</td><td headers="hd_h_niceng240er20.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>
|
||
<u>Ceftriaxone</u>
|
||
</p>
|
||
<p>IV ceftriaxone 80-100 mg/kg once daily for 4 days</p>
|
||
</td><td headers="hd_h_niceng240er20.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>
|
||
<u>Benzylpenicillin sodium</u>
|
||
</p>
|
||
<p>IV penicillin G 500,000 units/kg/day in 6 divided doses for 5 days</p>
|
||
</td><td headers="hd_h_niceng240er20.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<ul><li class="half_rhythm"><div>All-cause mortality</div></li><li class="half_rhythm"><div>CSF sterilisation</div></li></ul></td><td headers="hd_h_niceng240er20.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population is indirect due to 33% of population with meningo-coccaemia alone</td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt></dt><dd><div><p class="no_margin">CSF: cerebrospinal fluid; IV: intravenous; RCT: randomised controlled trial; SD: standard deviation</p></div></dd></dl></div></div></div></div></div><div><p>Final</p></div><div><p>Evidence review underpinning recommendations 1.6.4, 1.6.15 and 1.6.16 in the NICE guideline</p><p>This evidence review was developed by NICE</p></div><div><p><b>Disclaimer</b>: The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.</p><p>Local commissioners and/or providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties.</p><p>NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the <a href="http://wales.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Welsh Government</a>, <a href="http://www.scotland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Scottish Government</a>, and <a href="http://www.northernireland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Northern Ireland Executive</a>. All NICE guidance is subject to regular review and may be updated or withdrawn.</p></div></div></div>
|
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<div class="post-content"><div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright</a> © NICE 2024.</div><div class="small"><span class="label">Bookshelf ID: NBK604080</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/38829980" title="PubMed record of this title" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">38829980</a></span></div></div></div>
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