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We enrolled 43 children admitted with an unequivocal clinical diagnosis of meningococcal sepsis into a study to determine whether cefotaxime eradicated nasopharyngeal carriage of Neisseria meningitidis. In 28 cases (70%) the diagnosis was confirmed by positive culture from blood, nose, throat, or skin scraping, detection of meningococcal DNA in blood by polymerase chain reaction, or convalescent meningococcal serology. All children were treated with intravenous cefotaxime for seven days. Nasopharyngeal and throat swabs were obtained on the day of admission in 42 of these children, and all children had swabs repeated every day until there were at least two negative swabs.
On admission, the throat and nasopharyngeal swabs were both positive for meningococcus in two patients; in another two patients, the nasopharyngeal swab was positive while the throat swab was negative. In three patients the swabs became negative after 24 hours of treatment, and in one child it became negative after 48 hours. In these children and others in whom the swabs were negative from the day of admission, subsequent swabs remained negative.
Compared to a previous study1 that reported a nasopharyngeal carriage rate of 50% on admission and showed that the yield of meningococci in throat swabs was unaffected by prior administration of penicillin, the yield from throat and nose swabs in this study (9.5%) was poor. This may reflect the fact that in practice many of these swabs were taken after the child had been given the first dose of cefotaxime. The study suggests that cefotaxime, like ceftriaxone,2 is effective in eradicating nasopharyngeal carriage, and in children treated with cefotaxime, additional prophylaxis with rifampicin is not necessary. However, no recommendations for the use of cefotaxime alone can emanate from these findings as the sample size was small and study design did not compare cefotaxime with gold standard treatment (either rifampicin or ceftriaxone). We are keen to coordinate a follow up multicentre study this winter involving paediatric intensive care units across the country to compare the efficacy of ceftriaxone with cefotaxime on eradication of meningococcal carriage. Interested units are kindly requested to contact us.
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