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EDITORIALS: Duncan Keeley Parenteral penicillin before admission to hospital for meningitis BMJ 2006; 332: 1283-1284 [Full text]

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Remember ABC

Declan P Fox   (3 June 2006)

Rapid elimination of the offending microbe. Can it ever be harmful?

Nadaraja Bathirunathan   (4 June 2006)

Remember ABC 3 June 2006
Declan P Fox, Freelance physician Based in N Ireland BT784NP Send response to journal: Re: Remember ABC	Meningitis or septicaemia in childhood should receive the standard emergency care approach of ABC assessment, administration of oxygen followed by IV or intra-osseous fluids and only then considering definitive treatment. Parenteral antibiotics definitely fall into the last category. I have no strong views on giving or with-holding antibiotics but I think that it makes more sense to emphasise the standard ABC approach rather than beat up GPs for not giving Penicillin on suspicion. Declan Fox Freelance physician PALS and ATLS certified Competing interests: None declared
Rapid elimination of the offending microbe. Can it ever be harmful? 4 June 2006
Nadaraja Bathirunathan, Visiting Professor, Dept. Transfusion Medicine MGR Medical University,Guindy, Chennai 600032 Send response to journal: Re: Rapid elimination of the offending microbe. Can it ever be harmful?	I have heard these arguments before from indigenous medical practitioners African,Ayurvedic ,Unani, Chinese etc. Not everything that stands to reason proves to be the case. Our treatment donot need any proof. Western drugs have such dangerous side effects not known with our medicines.e.g rapid killing and lysis of bacteria by antibiotics might cause clinical deterioration. Facts are twisted to prove their point. Very few patients die in our hands. They die in the Hospital. Patients are usually mucked up by the indigenous practitioner and brought to die in the hospital. Children who are given penicillin are seven times more likely to die! The fact that children who were given penicillin were already severely ill is not just one likely explanaton.This is not something which is "intuitively probable' but a real fact. Just look at Figure 2. Most of the GPs are able to diagnose meningitis and give penicillin only when the children had more advanced disease. Parenteral antibiotics given before other supportive measures would lead to worse outcomes.What is the evidence? Antibiotics are given only for one purpose. To eliminate the offending microbes as quickly and completely as possible. Antibiotics cannot correct hypoxia, hypovolaemia , or provide inotropic or ventilatory support. These complications are brought about by the uncontrolled growth of the pathogen which ideally should have been eliminated by prompt and efficient antibiotic treatment in the first place.. How ridiculous would it be to wait till these conditions develop, treat them and then give antibiotics! Even when these complications have already developed is there any evidence that killing and lysis of bacteria worsens the outcome? I would like to know.There is no doubt that the supportive measures are vital, but the rapid elimination of the offending organisms should only make a positive contribution to the outcome. email: b3nathan@yahoo.co.uk Competing interests: None declared