Early treatment with parenteral penicillin in meningococcal disease.
OBJECTIVE
To measure the effect of parenteral antibiotics given before admission to hospital on mortality and on bacteriological investigations in meningococcal disease.


METHODS
Retrospective review of hospital notes and laboratory and public health medicine department records.


METHODS
Three health districts in south west England.


METHODS
Patients with meningococcal disease in Gloucester district presenting between 1 January 1982 and 31 December 1991 (n = 190); patients with meningococcal disease in Plymouth (n = 118) and Bath (n = 73) districts presenting between 1 January 1988 and 31 December 1991 (total = 381).


METHODS
Number of deaths from meningococcal disease.


RESULTS
Parenteral antibiotic given by general practitioners was associated with a substantial reduction in mortality (from 9% to 5%; relative risk 0.6, 95% confidence interval 0.2 to 1.5); patients with a rash were more likely to be given parenteral antibiotics, and mortality was further reduced (from 12% to 5%; 0.5, 0.2 to 1.4). In a district where such treatment was regularly encouraged its use increased from 5% to 40% of cases over 10 years (p = 0.00001). Treatment with parenteral antibiotics before admission made isolation of meningococci from blood and cerebrospinal fluid less likely but did not affect nasopharyngeal cultures.


CONCLUSIONS
General practitioners should carry benzylpenicillin in their emergency bags at all times and should administer it promptly, preferably intravenously, whenever meningococcal disease is suspected, unless the patient has had an anaphylactic reaction to penicillin. Specimens for culture should include a nasopharyngeal swab.
Cartwright
K
K
Public Health Laboratory, Gloucestershire Royal Hospital.
Reilly
S
S
White
D
D
Stuart
J
J
D006801:Humans; D007263:Infusions, Parenteral; D008585:Meningitis, Meningococcal / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality; D008589:Meningococcal Infections / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D009305:Nasopharynx / Q000382:microbiology; D009345:Neisseria meningitidis / Q000302:isolation & purification; D010343:Patient Admission; D010400:Penicillin G / Q000008:administration & dosage / Q000627:therapeutic use*; D011379:Prognosis; D018805:Sepsis / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome
D010400:Penicillin G