Borrowing strength from external trials in a meta-analysis

Antibiotics for eradicating meningococcal carriages: Network meta-analysis and investigation of evidence inconsistency

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.