title: Outcome of pre-hospital antibiotic treatment of meningococcal disease.
abstract: OBJECTIVE
  To assess the effect of pre-hospital antibiotic treatment given by general practitioners to patients with meningococcal disease.
  
  
  METHODS
  A 16-year population-based historical follow-up study based on referral letters and hospital records in the County of North Jutland, Denmark.
  
  
  METHODS
  320 patients with meningococcal disease, of whom 302 were examined by a general practitioner before admission to hospital.
  
  
  METHODS
  Death.
  
  
  RESULTS
  44 patients (14.6%) were given antibiotic treatment by the referring general practitioner. Nine of these (20.5%) died, compared with 16 (6.2%) patients who did not receive pre-hospital antibiotic treatment. The presence of skin bleeding, petechiae, and impaired consciousness were strongly associated with case fatality. Even after adjustment for these variables the odds ratio (OR) for death in patients treated with antibiotics was high (OR = 3.2; 95% CI, 0.9-10.6). In the 15 patients with skin bleeding (ecchymoses, suggillations) the case fatality rate was 100% in patients treated with antibiotics, and 50% in patients who did not receive antibiotics before hospitalization. If skin bleeding was replaced in the models by the presence of disseminated intravascular coagulation on admission, the OR for death in patients with pre-hospital antibiotic treatment was 35.9 (95% CI, 2.9-441.8) in the presence of disseminated intravascular coagulation and 1.9 (95% CI, 0.2-19.5) in its absence.
  
  
  CONCLUSIONS
  Pre-hospital treatment is mainly given to the most severe cases with expected high case fatality, and this confounding by indication was probably not fully adjusted for with the available data. The results contradict previous findings but provide reason to doubt the benefit of pre-hospital antibiotic treatment in patients with meningococcal disease.
authors.affiliation: The Danish Epidemiology Science Centre at the Department of Epidemiology and Social Medicine, University of Aarhus.
authors.forename: H T
authors.initials: HT
authors.lastname: Sørensen
authors.forename: G L
authors.initials: GL
authors.lastname: Nielsen
authors.forename: H C
authors.initials: HC
authors.lastname: Schønheyder
authors.forename: F H
authors.initials: FH
authors.lastname: Steffensen
authors.forename: I
authors.initials: I
authors.lastname: Hansen
authors.forename: S
authors.initials: S
authors.lastname: Sabroe
authors.forename: J F
authors.initials: JF
authors.lastname: Dahlerup
authors.forename: H
authors.initials: H
authors.lastname: Hamburger
authors.forename: J
authors.initials: J
authors.lastname: Olsen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D003718:Denmark / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008589:Meningococcal Infections / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D008875:Middle Aged; D009345:Neisseria meningitidis / Q000302:isolation & purification; D010400:Penicillin G / Q000627:therapeutic use*; D010406:Penicillins / Q000627:therapeutic use*; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D010406:Penicillins; D010400:Penicillin G