BMJ  2006;332 (3 June), doi:10.1136/bmj.332.7553.0

Prehospital penicillin for meningococcal disease might be harmful...

In a case-control study Harnden and colleagues (p 1295) found that administration of parenteral penicillin in primary care to children suspected of having meningococcal disease was associated with a sevenfold increase in mortality. The study included 158 children treated for meningococcal disease in England, Wales, and Northern Ireland between 1997 and 1999 who were diagnosed by a general practitioner before referral to a hospital. In an accompanying commentary, Perera (p 1297) warns how a simple choice in the analysis can change the results from modestly beneficial to substantially harmful. He also questions whether the variables used in the study sufficiently adjusted for severity of the disease.

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