Parenteral penicillin for children with meningococcal disease before hospital admission: a case-control study

doi:10.1136/bmj.38789.723611.55

BMJ, doi: 10.1136/bmj.38789.723611.55, (Published 22 March 2006)

RESEARCH

Parenteral penicillin for children with meningococcal disease before hospital admission: a case-control study

Anthony Harnden ¹^*, Nelly Ninis ², Matthew Thompson ¹, Rafael Perera ¹, Michael Levin ³, David Mant ¹, Richard Mayon-White ¹

¹ Department of Primary Health Care, Institute of Health Sciences, University of Oxford, Oxford OX3 7LF
² Department of Paediatrics, Faculty of Medicine, Imperial College, London
³ Division of Medicine, Brighton and Sussex Medical School, Brighton

^* Correspondence to: anthony.harnden{at}dphpc.ox.ac.uk.

Objective To explore the impact on mortality and morbidity ofparenteral penicillin given to children before admission tohospital with suspected meningococcal disease.

Design Retrospectivecomparison of fatal and non-fatal cases.

Setting England, Wales,and Northern Ireland; December 1997 to February 1999.

Participants158 children aged 0-16 years (26 died, 132 survived) in whoma general practitioner had made the diagnosis of meningococcaldisease before hospital admission.

Results Administration ofparenteral penicillin by general practitioners was associatedwith increased odds ratios for death (7.4, 95% confidence interval1.5 to 37.7) and complications in survivors (5.0, 1.7 to 15.0).Children who received penicillin had more severe disease onadmission (median Glasgow meningococcal septicaemia prognosticscore (GMSPS) 6.5 v 4.0, P=0.002). Severity on admission didnot differ significantly with time taken to reach hospital.

ConclusionsChildren who were given parental penicillin by a general practitionerhad more severe disease on reaching hospital than those whowere not given penicillin before admission. The associationwith poor outcome may be because more severely ill childrenare being given penicillin before admission.

(Accepted 23 February 2006)

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