title: Effectiveness of antibiotics given before admission in reducing mortality from meningococcal disease: systematic review.
abstract: OBJECTIVE
  To review the evidence for effectiveness of treatment with antibiotics before admission in reducing case fatality from meningococcal disease.
  
  
  METHODS
  Systematic review.
  
  
  METHODS
  Cochrane register of trials and systematic reviews, database of abstracts of reviews of effectiveness, health technology assessment, and national research register in England and Wales, Medline, Embase, and CAB Health.
  
  
  METHODS
  Studies describing vital outcome of at least 10 cases of meningococcal disease classified by whether or not antibiotics were given before admission to hospital.
  
  
  RESULTS
  14 observational studies met the review criteria. Oral antibiotic treatment given before admission was associated with reduced mortality among cases (combined risk ratio 0.17, 95% confidence interval 0.07 to 0.44). In seven studies in which all included patients were seen in primary care, the association between parenteral antibiotics before admission and outcome was inconsistent (chi2 for heterogeneity 11.02, P = 0.09). After adjustment for the proportion given parenteral antibiotics before admission, there was no residual heterogeneity. A higher proportion of patients given parenteral antibiotics before admission was associated with reduced mortality after such treatment and vice versa (P = 0.04).
  
  
  CONCLUSIONS
  Confounding by severity is the most likely explanation both for the beneficial effect of oral antibiotics and the harmful effect observed in some studies of parenteral antibiotics. We cannot conclude whether or not antibiotics given before admission have an effect on case fatality. The data are consistent with benefit when a substantial proportion of cases are treated.
authors.affiliation: National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands. susan.hahne@rivm.nl
authors.forename: Susan J M
authors.initials: SJ
authors.lastname: Hahné
authors.forename: André
authors.initials: A
authors.lastname: Charlett
authors.forename: Bernadette
authors.initials: B
authors.lastname: Purcell
authors.forename: Susanne
authors.initials: S
authors.lastname: Samuelsson
authors.forename: Ivonne
authors.initials: I
authors.lastname: Camaroni
authors.forename: Ingrid
authors.initials: I
authors.lastname: Ehrhard
authors.forename: Sigrid
authors.initials: S
authors.lastname: Heuberger
authors.forename: Maria
authors.initials: M
authors.lastname: Santamaria
authors.forename: James M
authors.initials: JM
authors.lastname: Stuart
mesh_terms: D000284:Administration, Oral; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007263:Infusions, Parenteral; D008589:Meningococcal Infections / Q000188:drug therapy* / Q000401:mortality; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents