Meningitis and single-dose Cipro

As often happens, a half-hour of research answered my question. A number of studies listed at the end of this post show that one 500 mg dose of Ciprofloxacin eliminates N. meningitis from nasal passages of carriers somewhere upwards of 95% of the time. In a study of personnel at a naval training center in Britain (abstract, full text available as PDF on same page), researchers reduced prevalence of N. meningitis from 19% to 1.5% after handing out Cipro to 2100 people at the facility.

Grains of salt here: These studies were all done in the late 1980's. Cipro first hit the market in 1987. Reports of N. meningitis that doesn't respond as well to cipro have been found in Spain (free full text) as of 2004. I haven't dug into these articles very far, but thus far the 1099 Dworzack article I used as a source of references found negative nasal swabs 20 days post treatment. Given the presence of N. meningitis in the environment, I wonder if many of the subjects were reinfected at some point after treatment.

Eradication of microbes is not easy, and rarely if ever is achieved for long periods of time.

Meningitis is a hell of an infection, as my experience over the past week has shown me. Incidentally, my brother, who was 3 at the time, almost died of meningitis shortly before I came into the world. They cultured meningococcus from my sister's sputum shortly thereafter, though like most people, she had never been ill.

Someday, I imagine we'll be able to tell why some folks get sick and others don't.

This is giving me a headache. (No neck tenderness yet, though.) Time to give it a rest.

zaius

List of references from
Dworzack, D.L., C.C. Sanders, E.A. Horowitz, J.M. Allais, M. Sookpranee, W.E. Sanders, Jr., and F.M. Ferraro. 1988.Evaluation of Single-Dose Ciprofloxacin in the Eradication of Neisseria meningitidis from Nasopharyngeal Carriers. ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, 32:1740-1741.

Pugsley, M. P., D. L. Dworzack, E. A. Horowitz, T. A. Cuevas, W. E. Sanders, Jr., and C. C. Sanders. 1987. Efficacy of ciprofloxacin in the treatment of nasopharyngeal carriers of
Neisseria meningitidis. J. Infect. Dis. 156:211-213.

Pugsley, M. P., D. L. Dworzack, J. S. Roccaforte, C. C. Sanders, J. S. Bakken, and W. E. Sanders, Jr. 1988. An open study of the efficacy of a single dose of ciprofloxacin in eliminating the
chronic nasopharyngeal carriage of Neisseria meningitidis. J. Infect. Dis. 157:852-853.

Renkonen, 0. V., A. Sivonen, and R. Visakorpi. 1987. Effect of ciprofloxacin on carrier rate of Neisseria meningitidis in army recruits in Finland. Antimicrob. Agents Chemother. 31:962-
963.

Schwartz, B., A. Al-Ruwais, J. A'ashi, C. V. Broome, A. Al-Tobaiqi, R. F. Fontaine, A. W. Hightower, and S. I. Music. 1988. Comparative efficacy of ceftriaxone and rifampicin in
eradicating pharyngeal carriage of group A Neisseria meningitidis. Lancet i:1239-1242.

Ullman, U., W. Giebel, A. Dalhoff, and P. Koeppe. 1985. Penetration of ciprofloxacin into nasal secretions, p. 1583-1584. In J. Ishigami (ed.), Recent advances in chemotherapy. University
of Tokyo Press, Tokyo.