Parenteral penicillin for children with meningococcal disease before hospital admission: case-control study.
OBJECTIVE
To explore the impact on mortality and morbidity of parenteral penicillin given to children before admission to hospital with suspected meningococcal disease.


METHODS
Retrospective comparison of fatal and non-fatal cases.


METHODS
England, Wales, and Northern Ireland; December 1997 to February 1999.


METHODS
158 children aged 0-16 years (26 died, 132 survived) in whom a general practitioner had made the diagnosis of meningococcal disease before hospital admission.


RESULTS
Administration of parenteral penicillin by general practitioners was associated with increased odds ratios for death (7.4, 95% confidence interval 1.5 to 37.7) and complications in survivors (5.0, 1.7 to 15.0). Children who received penicillin had more severe disease on admission (median Glasgow meningococcal septicaemia prognostic score (GMSPS) 6.5 v 4.0, P = 0.002). Severity on admission did not differ significantly with time taken to reach hospital.


CONCLUSIONS
Children who were given parenteral penicillin by a general practitioner had more severe disease on reaching hospital than those who were not given penicillin before admission. The association with poor outcome may be because children who are more severely ill are being given penicillin before admission.
Department of Primary Health Care, Institute of Health Sciences, University of Oxford, Oxford OX3 7LF. anthony.harnden@dphpc.ox.ac.uk Abstract
Anthony
A
Harnden
Nelly
N
Ninis
Matthew
M
Thompson
Rafael
R
Perera
Michael
M
Levin
David
D
Mant
Richard
R
Mayon-White
D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D004632:Emergency Medical Services; D004739:England / Q000453:epidemiology; D005194:Family Practice; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007263:Infusions, Parenteral; D008297:Male; D008585:Meningitis, Meningococcal / Q000188:drug therapy* / Q000401:mortality; D009660:Northern Ireland / Q000453:epidemiology; D010406:Penicillins / Q000008:administration & dosage*; D012044:Regression Analysis; D012307:Risk Factors; D013997:Time Factors; D014852:Wales / Q000453:epidemiology
D000900:Anti-Bacterial Agents; D010406:Penicillins