Susan J M Hahné, André Charlett, Bernadette Purcell, Susanne Samuelsson, Ivonne Camaroni, Ingrid Ehrhard et al
Hahné S J M, Charlett A, Purcell B, Samuelsson S, Camaroni I, Ehrhard I et al.
Effectiveness of antibiotics given before admission in reducing mortality from meningococcal disease: systematic review
BMJ 2006; 332 :1299
doi:10.1136/bmj.332.7553.1299
Administering prehospital penicillin reflects good practice
The mortality of meningococcal disease in children has been
decreasing over the last decade. This has been attributed to an
improvement in the overall care which begins from recognition of the
illness by the general practitioner up to appropriate management in
specialist paediatric intensive care units (PICU) (1,2) . The paediatric
department in our hospital provides a comprehensive care to acutely ill
children including provision of intensive care. Over a 5 year period (1998
– 2002) we admitted 139 children within our catchment area with
meningococcal disease. Though 90(65%) children were referred to the
hospital by their general practitioners, only one third (31 patients)
received parenteral benzyl penicillin. Fifty eight (42%) children had
illness severe enough to get admitted to PICU. Despite these facts, only 4
children died giving an overall mortality of only 3%.But interestingly,
all those who died did not receive prehospital parenteral penicillin.
Such low mortality figures have been published by various paediatric
intensive care units (1,2) .We are concerned such low figures might create
a degree of complacency among the health care providers in early
recognition of this deadly illness. Having a strong suspicion on any
acutely unwell child and carefully looking for signs of meningococcal
disease will not only enable the general practitioners to give parenteral
benzyl penicillin but also initiate the cascade of prompt treatment
strategies such as rapid transfer of the child to hospital and alerting
the hospital staff. Therefore, though the recent research paper published
in BMJ on the role of prehospital parenteral penicillin (3) and the
systematic review on this subject(4) did not provide conclusive evidence
for the role of parenteral penicillin, administration of penicillin by the
general practitioner indirectly implies that he/she has strongly
considered the possibility of meningococcal disease by carefully looking
for it’s symptoms and signs which in turn will lead on to rapid initiation
of appropriate treatment in hospital resulting in reduced mortality.
1. Booy R,Habibi P,Nadel S,De Munter C,Britto J,Morrison A,Levin M
and the meningococcal research group. Reduction in case fatality rate from
meningococcal disease associated with improved health care delivery. Arch
Dis Child 2001;85:386-390.
2.Thorburn K,Baines P,Thomson A, Hart H A. Mortality in severe
meningococcal disease. Arch Dis Child 2001;85:382-385.
3.Harnden A,Ninis N,Thompson M,Perera R,Leven M,Mant D,Mayon-White R
.Parenteral penicillin for children with meningococcal disease before
hospital admission: case control study.BMJ2006;332:1295-8.
4.Hahne S J M,Charlet A, Purcell B,Samuelsson S,Camaroni I, Ehrhard I
et al.Effectiveness of antibiotics given before admission in reducing
mortality from meningococcal disease: systematic review.BMJ 2006;332:1299-
301.
Competing interests:
None declared
Competing interests: No competing interests