BMJ  2006;332:1283-1284 (3 June), doi:10.1136/bmj.332.7553.1283

Editorial

Parenteral penicillin before admission to hospital for meningitis

The benefit remains uncertain despite new evidence

The first 150 words of the full text of this article appear below.

General practitioners worry about seeing—and even more about missing—meningococcal disease. We know that affected children can deteriorate very rapidly and that the disease has a high mortality. And we know that if we suspect this diagnosis we should give parenteral penicillin while arranging urgent transfer to hospital. This is the advice in the British National Formulary, the Drug and Therapeutics Bulletin, and the guidelines for general practitioners from the Meningitis Research Foundation.¹

It stands to reason that in a rapidly progressive bacterial infection the earliest possible administration of antibiotics should have a beneficial effect on outcomes. We carry the penicillin in our bags. But not everything that stands to reason proves to be the case—and the uncertainty of the evidence base for prehospital administration of penicillin in suspected meningococcal disease is added to by a paper published in this week's BMJ.²

This study (p 1295. . . [Full text of this article]

The Health Centre, Thame OX9 3JZ
(duncan.keeley@nhs.net)

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