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

Letter

Prehospital parenteral penicillin for meningitis

Trial in children with suspected meningococcal disease would be useful

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

EDITOR—Harnden et al's study raises important questions about the role of prehospital parenteral penicillin in children with meningococcal disease.¹ Their paper and accompanying statistical comment have shown the potential importance of excluding patients who would never have been considered for treatment. However, their study design is likely to have excluded a group of children with suspected meningococcal disease who were given prehospital parenteral penicillin.

Public health guidelines recommend that general administer prehospital parenteral penicillin to patients with suspected meningococcal disease, though the guidelines do not make specific recommendations about the clinical criteria on which general practitioners should base their decision.² Recent research shows that clinical features other than haemorrhagic rash can be important in identifying meningococcal disease,³ reinforcing how difficult clinical decisions can be when treating an acutely unwell child.

In contrast, the formal case definition for meningococcal disease is decided after consultation between hospital clinician, microbiologist, and . . . [Full text of this article]

gm@nhs.net, Cameron House, Windygates, Leven, Fife KY8 5RG

Cameron House, Windygates, Leven, Fife KY8 5RG

Hayfield House, Kirkcaldy, Fife KY2 5AH

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