Variations in chemoprophylaxis for meningococcal disease: a retrospective case note review, analysis of routine prescribing data and questionnaire of general practitioners.
BACKGROUND
Invasive meningococcal disease is a significant cause of mortality and morbidity in the UK. Administration of chemoprophylaxis to close contacts reduces the risk of a secondary case. However, unnecessary chemoprophylaxis may be associated with adverse reactions, increased antibiotic resistance and removal of organisms, such as Neisseria lactamica, which help to protect against meningococcal disease. Limited evidence exists to suggest that overuse of chemoprophylaxis may occur. This study aimed to evaluate prescribing of chemoprophylaxis for contacts of meningococcal disease by general practitioners and hospital staff.


METHODS
Retrospective case note review of cases of meningococcal disease was conducted in one health district from 1st September 1997 to 31st August 1999. Routine hospital and general practitioner prescribing data was searched for chemoprophylactic prescriptions of rifampicin and ciprofloxacin. A questionnaire of general practitioners was undertaken to obtain more detailed information.


RESULTS
Prescribing by hospital doctors was in line with recommendations by the Consultant for Communicable Disease Control. General practitioners prescribed 118% more chemoprophylaxis than was recommended. Size of practice and training status did not affect the level of additional prescribing, but there were significant differences by geographical area. The highest levels of prescribing occurred in areas with high disease rates and associated publicity. However, some true close contacts did not appear to receive prophylaxis.


CONCLUSIONS
Receipt of chemoprophylaxis is affected by a series of patient, doctor and community interactions. High publicity appears to increase demand for prophylaxis. Some true contacts do not receive appropriate chemoprophylaxis and are left at an unnecessarily increased risk.
Marks
P J
PJ
Division of Public Health Sciences, University of Nottingham, Nottingham, UK.
Neal
K R
KR
D000890:Anti-Infective Agents / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis / Q000706:statistics & numerical data*; D000904:Antibiotics, Antitubercular / Q000627:therapeutic use; D002939:Ciprofloxacin / Q000627:therapeutic use; D016358:Contact Tracing; D017723:Drug Utilization Review; D005194:Family Practice; D006801:Humans; D008505:Medical Staff, Hospital / Q000706:statistics & numerical data; D008589:Meningococcal Infections / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control*; D010821:Physicians, Family / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012293:Rifampin / Q000627:therapeutic use; D011795:Surveys and Questionnaires; D006113:United Kingdom / Q000453:epidemiology
D000890:Anti-Infective Agents; D000904:Antibiotics, Antitubercular; D002939:Ciprofloxacin; D012293:Rifampin