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. 1992 Jul 18;305(6846):143–147. doi: 10.1136/bmj.305.6846.143

Early treatment with parenteral penicillin in meningococcal disease.

K Cartwright 1, S Reilly 1, D White 1, J Stuart 1
PMCID: PMC1883180  PMID: 1515827

Abstract

OBJECTIVE--To measure the effect of parenteral antibiotics given before admission to hospital on mortality and on bacteriological investigations in meningococcal disease. DESIGN--Retrospective review of hospital notes and laboratory and public health medicine department records. SETTING--Three health districts in south west England. SUBJECTS--Patients with meningococcal disease in Gloucester district presenting between 1 January 1982 and 31 December 1991 (n = 190); patients with meningococcal disease in Plymouth (n = 118) and Bath (n = 73) districts presenting between 1 January 1988 and 31 December 1991 (total = 381). MAIN OUTCOME MEASURE--Number of deaths from meningococcal disease. RESULTS--Parenteral antibiotic given by general practitioners was associated with a substantial reduction in mortality (from 9% to 5%; relative risk 0.6, 95% confidence interval 0.2 to 1.5); patients with a rash were more likely to be given parenteral antibiotics, and mortality was further reduced (from 12% to 5%; 0.5, 0.2 to 1.4). In a district where such treatment was regularly encouraged its use increased from 5% to 40% of cases over 10 years (p = 0.00001). Treatment with parenteral antibiotics before admission made isolation of meningococci from blood and cerebrospinal fluid less likely but did not affect nasopharyngeal cultures. CONCLUSIONS--General practitioners should carry benzylpenicillin in their emergency bags at all times and should administer it promptly, preferably intravenously, whenever meningococcal disease is suspected, unless the patient has had an anaphylactic reaction to penicillin. Specimens for culture should include a nasopharyngeal swab.

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Selected References

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  1. Abbott J. D., Jones D. M., Painter M. J., Young S. E. The epidemiology of meningococcal infections in England and Wales, 1912-1983. J Infect. 1985 Nov;11(3):241–257. doi: 10.1016/s0163-4453(85)93294-3. [DOI] [PubMed] [Google Scholar]
  2. Abramson J. S., Spika J. S. Persistence of Neisseria meningitidis in the upper respiratory tract after intravenous antibiotic therapy for systemic meningococcal disease. J Infect Dis. 1985 Feb;151(2):370–371. doi: 10.1093/infdis/151.2.370. [DOI] [PubMed] [Google Scholar]
  3. Andersen B. M., Solberg O. The endotoxin-liberating effect of antibiotics on meningococci in vitro. Acta Pathol Microbiol Scand B. 1980 Aug;88(4):231–236. doi: 10.1111/j.1699-0463.1980.tb02633.x. [DOI] [PubMed] [Google Scholar]
  4. Baxter P., Priestley B. Meningococcal rash. Lancet. 1988 May 21;1(8595):1166–1167. doi: 10.1016/s0140-6736(88)91981-2. [DOI] [PubMed] [Google Scholar]
  5. Bjune G., Høiby E. A., Grønnesby J. K., Arnesen O., Fredriksen J. H., Halstensen A., Holten E., Lindbak A. K., Nøkleby H., Rosenqvist E. Effect of outer membrane vesicle vaccine against group B meningococcal disease in Norway. Lancet. 1991 Nov 2;338(8775):1093–1096. doi: 10.1016/0140-6736(91)91961-s. [DOI] [PubMed] [Google Scholar]
  6. Brandtzaeg P., Kierulf P., Gaustad P., Skulberg A., Bruun J. N., Halvorsen S., Sørensen E. Plasma endotoxin as a predictor of multiple organ failure and death in systemic meningococcal disease. J Infect Dis. 1989 Feb;159(2):195–204. doi: 10.1093/infdis/159.2.195. [DOI] [PubMed] [Google Scholar]
  7. Cartwright K. A., Jones D. M. Value of throat swabs from index cases of meningococcal meningitis. J Clin Pathol. 1990 May;43(5):438–438. doi: 10.1136/jcp.43.5.438-a. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Cartwright K. A., Stuart J. M., Noah N. D. An outbreak of meningococcal disease in Gloucestershire. Lancet. 1986 Sep 6;2(8506):558–561. doi: 10.1016/s0140-6736(86)90124-8. [DOI] [PubMed] [Google Scholar]
  9. Converse G. M., Gwaltney J. M., Jr, Strassburg D. A., Hendley J. O. Alteration of cerebrospinal fluid findings by partial treatment of bacterial meningitis. J Pediatr. 1973 Aug;83(2):220–225. doi: 10.1016/s0022-3476(73)80479-2. [DOI] [PubMed] [Google Scholar]
  10. DeVoe I. W. The meningococcus and mechanisms of pathogenicity. Microbiol Rev. 1982 Jun;46(2):162–190. doi: 10.1128/mr.46.2.162-190.1982. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Edwards E. A., Devine L. F., Sengbusch G. H., Ward H. W. Immunological investigations of meningococcal disease. III. Brevity of group C acquisition prior to disease occurrence. Scand J Infect Dis. 1977;9(2):105–110. doi: 10.3109/inf.1977.9.issue-2.09. [DOI] [PubMed] [Google Scholar]
  12. Fallon R. J., Brown W. M., Lore W. Meningococcal infections in Scotland 1972-82. J Hyg (Lond) 1984 Oct;93(2):167–180. doi: 10.1017/s0022172400064688. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Gedde-Dahl T. W., Høiby E. A., Brandtzaeg P., Eskerud J. R., Bøvre K. Some arguments on early hospital admission and treatment of suspected meningococcal disease cases. NIPH Ann. 1990 Dec;13(2):45–60. [PubMed] [Google Scholar]
  14. Goldacre M. J. Acute bacterial maningitis in childhood: aspects of prehospital care in 687 cases. Arch Dis Child. 1977 Jun;52(6):501–503. doi: 10.1136/adc.52.6.501. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Goldacre M. J., Miller D. L. Completeness of statutory notification for acute bacterial meningitis. Br Med J. 1976 Aug 28;2(6034):501–503. doi: 10.1136/bmj.2.6034.501. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Jarvis C. W., Saxena K. M. Does prior antibiotic treatment hamper the diagnosis of acute bacterial meningitis? An analysis of a series of 135 childhood cases. Clin Pediatr (Phila) 1972 Apr;11(4):201–204. doi: 10.1177/000992287201100406. [DOI] [PubMed] [Google Scholar]
  17. Lieberman J. M., Greenberg D. P., Ward J. I. Prevention of bacterial meningitis. Vaccines and chemoprophylaxis. Infect Dis Clin North Am. 1990 Dec;4(4):703–729. [PubMed] [Google Scholar]
  18. Mellado M. C., Rodríguez-Contreras R., Mariscal A., Luna J. D., Delgado Rodríguez M., Galvez-Vargas R. Effect of penicillin and chloramphenicol on the growth and endotoxin release by N. meningitidis. Epidemiol Infect. 1991 Apr;106(2):283–288. doi: 10.1017/s0950268800048421. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Niklasson P. M., Lundbergh P., Strandell T. Prognostic Factors in meningococcal disease. Scand J Infect Dis. 1971;3(1):17–25. doi: 10.3109/inf.1971.3.issue-1.03. [DOI] [PubMed] [Google Scholar]
  20. Oakley J. R., Stanton A. N. Meningococcal infections during infancy: confidential inquiries into 10 deaths. Br Med J. 1979 Aug 25;2(6188):468–469. doi: 10.1136/bmj.2.6188.468. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Ong E. L., Dunbar E. M. Antibiotics carried in general practitioners' emergency bags. BMJ. 1988 Oct 8;297(6653):901–901. doi: 10.1136/bmj.297.6653.901. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Sippel J. E., Girgis N. I. Throat culture from patients with meningococcal meningitis. J Clin Pathol. 1990 Jul;43(7):610–611. doi: 10.1136/jcp.43.7.610-c. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Slack J. Deaths from meningococcal infection in England and Wales in 1978. J R Coll Physicians Lond. 1982 Jan;16(1):40–44. [PMC free article] [PubMed] [Google Scholar]
  24. Stephens D. S., Farley M. M. Pathogenic events during infection of the human nasopharynx with Neisseria meningitidis and Haemophilus influenzae. Rev Infect Dis. 1991 Jan-Feb;13(1):22–33. doi: 10.1093/clinids/13.1.22. [DOI] [PubMed] [Google Scholar]
  25. Strang J. R., Pugh E. J. Meningococcal infections: reducing the case fatality rate by giving penicillin before admission to hospital. BMJ. 1992 Jul 18;305(6846):141–143. doi: 10.1136/bmj.305.6846.141. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Surtees S. J., Stockton M. G., Gietzen T. W. Allergy to penicillin: fable or fact? BMJ. 1991 May 4;302(6784):1051–1052. doi: 10.1136/bmj.302.6784.1051. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Talan D. A., Guterman J. J., Overturf G. D., Singer C., Hoffman J. R., Lambert B. Analysis of emergency department management of suspected bacterial meningitis. Ann Emerg Med. 1989 Aug;18(8):856–862. doi: 10.1016/s0196-0644(89)80213-6. [DOI] [PubMed] [Google Scholar]
  28. Talan D. A., Hoffman J. R., Yoshikawa T. T., Overturf G. D. Role of empiric parenteral antibiotics prior to lumbar puncture in suspected bacterial meningitis: state of the art. Rev Infect Dis. 1988 Mar-Apr;10(2):365–376. doi: 10.1093/clinids/10.2.365. [DOI] [PubMed] [Google Scholar]
  29. Toews W. H., Bass J. W. Skin manifestations of meningococcal infection; an immediate indicator of prognosis. Am J Dis Child. 1974 Feb;127(2):173–176. doi: 10.1001/archpedi.1974.02110210023003. [DOI] [PubMed] [Google Scholar]
  30. Tønjum T., Nilsson F., Bruun J. N., Haneberg B. The early phase of meningococcal disease. NIPH Ann. 1983 Dec;6(2):175–181. [PubMed] [Google Scholar]
  31. Waage A., Brandtzaeg P., Halstensen A., Kierulf P., Espevik T. The complex pattern of cytokines in serum from patients with meningococcal septic shock. Association between interleukin 6, interleukin 1, and fatal outcome. J Exp Med. 1989 Jan 1;169(1):333–338. doi: 10.1084/jem.169.1.333. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Waage A., Halstensen A., Espevik T. Association between tumour necrosis factor in serum and fatal outcome in patients with meningococcal disease. Lancet. 1987 Feb 14;1(8529):355–357. doi: 10.1016/s0140-6736(87)91728-4. [DOI] [PubMed] [Google Scholar]

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