BMJ  2006;332:1451 (17 June), doi:10.1136/bmj.332.7555.1451

Letter

Prehospital parenteral penicillin for meningitis

Urgent review of treatment criteria is needed

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

EDITOR—Harnden et al highlight an interesting problem in the early management of meningococcal disease: although it seems intuitively obvious that prehospital antibiotic treatment should improve outcome, this is extremely difficult to demonstrate objectively.1

In theory, at least three possibilities exist for the effect of early treatment on outcome, two of which are discussed by Harnden et al.

Firstly, they postulate that antibiotic administration is beneficial but that confounding by severity makes this hard to detect.

Secondly, they explore (and reject as unlikely) the possibility that antibiotic administration worsens the outcome by precipitating the release of endotoxin.

We suggest a third possibility: that in most cases prehospital antibiotic administration has little or no effect on mortality because the traditional diagnostic criteria for meningococcal disease reflect a stage of pathogenesis at which the opportunity for treatment benefit has already passed.

Shock, meningism, and petechial rash are manifestations of the profound . . . [Full text of this article]

Amanda J Kvalsvig, senior research fellow

amanda.kvalsvig@otago.ac.nz, Department of Public Health, Wellington School of Medicine and Health Sciences, University of Otago, PO Box 7343, Wellington, New Zealand

Michael Baker, senior lecturer

Department of Public Health, Wellington School of Medicine and Health Sciences, University of Otago, PO Box 7343, Wellington, New Zealand

Graham Mills, infectious diseases physician

Waikato Hospital, Private Bag 3200, Hamilton, New Zealand


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Relevant Article

Parenteral penicillin for children with meningococcal disease before hospital admission: case-control study
Anthony Harnden, Nelly Ninis, Matthew Thompson, Rafael Perera, Michael Levin, David Mant, and Richard Mayon-White
BMJ 2006 332: 1295-1298. [Abstract] [Full Text] [PDF]

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