Meta-Analysis
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Meta-Anal. Aug 26, 2016; 4(4): 77-87
Published online Aug 26, 2016. doi: 10.13105/wjma.v4.i4.77
Antibiotics for eradicating meningococcal carriages: Network meta-analysis and investigation of evidence inconsistency
Asmaa S Abdelhamid, Yoon K Loke, Ibrahim Abubakar, Fujian Song
Asmaa S Abdelhamid, Yoon K Loke, Fujian Song, Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, United Kingdom
Ibrahim Abubakar, Institute of Epidemiology and Health, University College of London, London WC1E 6BT, United Kingdom
Author contributions: Song F had the initial idea; Abdelhamid AS and Song F extracted data from the included trials; Song F conducted data analyses; Abdelhamid AS, Loke YK and Song F investigated causes of inconsistencies, and drafted the manuscript; Abubakar I provided clinical advice on the interpretation of results and critically commented on the manuscript; all authors approved the manuscript.
Supported by Partly the UK Medical Research Council, No. G0701607.
Conflict-of-interest statement: All authors declare no conflict of interest. The study design, data collection and interpretation have not been influenced by the funder.
Data sharing statement: All available data has been presented in the manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Fujian Song, PhD, Professor, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, United Kingdom. fujian.song@uea.ac.uk
Telephone: +44-1603-591253 Fax: +44-1603-59752
Received: April 25, 2016
Peer-review started: April 26, 2016
First decision: June 16, 2016
Revised: June 28, 2016
Accepted: July 14, 2016
Article in press: July 18, 2016
Published online: August 26, 2016
Processing time: 123 Days and 2.2 Hours
Abstract
AIM

To compare different antibiotics for eradicating the carriage of Neisseria meningitidis (N. meningitidis), and to investigate heterogeneity and evidence inconsistency.

METHODS

From a search of PubMed and published systematic reviews, we identified 23 trials evaluating 15 antibiotics that could be connected in a trial network. The outcome of interest is the eradication of N. meningitidis. We used WinBUGS to conduct random-effects, mixed treatment comparisons. Heterogeneity and evidence inconsistency was investigated by meta-regression modelling and examining characteristics of trial participants and interventions evaluated.

RESULTS

Rifampin, ciprofloxacin, minocycline, ceftriaxone, and azythromycin were statistically significantly (P < 0.05) more effective than placebo. The probability of being the best was 67.0% for a combination of rifampin and minocycline, 25.0% for ceftriaxone, 1.7% for azythromycin, and below 1% for the remaining regimens. Significant inconsistency between the direct and indirect estimates was observed for the comparison of rifampin and ciprofloxacin (P < 0.01), which may be caused by different types of carriers and different doses of ciprofloxacin.

CONCLUSION

A range of prophylactic antibiotic regimens are effective for eradicating meningococcal carriages, and treatment choice will depend on the individual priorities of the patients and physicians. In clinical situations where complete eradication is considered to be of the utmost importance, a combination of rifampin and minocycline seems to offer the highest likelihood of success. Ceftriaxone as a single intramuscular injection is also likely to be more effective as compared with the other two antibiotics (ciprofloxacin or rifampin) recommended by the current guidelines.

Keywords: Chemoprophylaxis; Antibiotics; Nersseria meningitidis; Meningococcal infection; Network meta-analysis

Core tip: This network meta-analysis found that a range of prophylactic antibiotic regimens are effective for eradicating meningococcal carriages. A combination of rifampin and minocycline seems the most efficacious, and ceftriaxone is also likely to be more effective than ciprofloxacin or rifampin alone. Careful investigation of significant inconsistency between direct and indirect comparison of rifampin and ciprofloxacin found that it was mainly caused by different types of carriers (persistent or any) and the varying doses of ciprofloxacin in the included trials. Detailed examination of characteristics of relevant studies should be conducted for investigating causes of inconsistency in network meta-analysis.