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RESEARCH: Susan J M Hahné, André Charlett, Bernadette Purcell, Susanne Samuelsson, Ivonne Camaroni, Ingrid Ehrhard, Sigrid Heuberger, Maria Santamaria, and James M Stuart Effectiveness of antibiotics given before admission in reducing mortality from meningococcal disease: systematic review BMJ 2006; 332: 1299-1303 [Abstract] [Full text]

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Administering prehospital penicillin reflects good practice

PAVANASAM RAMESH, JOHN ALEXANDER,Consultant Paediatrician,University Hospital of North Staffordshire,Stoke on Trent ST4 6QG   (10 June 2006)

Administering prehospital penicillin reflects good practice 10 June 2006
PAVANASAM RAMESH, Specialist Registrar in Paediatrics University Hospital of North Staffordshire,Stoke on Trent ST4 6QG, JOHN ALEXANDER,Consultant Paediatrician,University Hospital of North Staffordshire,Stoke on Trent ST4 6QG Send response to journal: Re: Administering prehospital penicillin reflects good practice	The mortality of meningococcal disease in children has been decreasing over the last decade. This has been attributed to an improvement in the overall care which begins from recognition of the illness by the general practitioner up to appropriate management in specialist paediatric intensive care units (PICU) (1,2) . The paediatric department in our hospital provides a comprehensive care to acutely ill children including provision of intensive care. Over a 5 year period (1998 – 2002) we admitted 139 children within our catchment area with meningococcal disease. Though 90(65%) children were referred to the hospital by their general practitioners, only one third (31 patients) received parenteral benzyl penicillin. Fifty eight (42%) children had illness severe enough to get admitted to PICU. Despite these facts, only 4 children died giving an overall mortality of only 3%.But interestingly, all those who died did not receive prehospital parenteral penicillin. Such low mortality figures have been published by various paediatric intensive care units (1,2) .We are concerned such low figures might create a degree of complacency among the health care providers in early recognition of this deadly illness. Having a strong suspicion on any acutely unwell child and carefully looking for signs of meningococcal disease will not only enable the general practitioners to give parenteral benzyl penicillin but also initiate the cascade of prompt treatment strategies such as rapid transfer of the child to hospital and alerting the hospital staff. Therefore, though the recent research paper published in BMJ on the role of prehospital parenteral penicillin (3) and the systematic review on this subject(4) did not provide conclusive evidence for the role of parenteral penicillin, administration of penicillin by the general practitioner indirectly implies that he/she has strongly considered the possibility of meningococcal disease by carefully looking for it’s symptoms and signs which in turn will lead on to rapid initiation of appropriate treatment in hospital resulting in reduced mortality. 1. Booy R,Habibi P,Nadel S,De Munter C,Britto J,Morrison A,Levin M and the meningococcal research group. Reduction in case fatality rate from meningococcal disease associated with improved health care delivery. Arch Dis Child 2001;85:386-390. 2.Thorburn K,Baines P,Thomson A, Hart H A. Mortality in severe meningococcal disease. Arch Dis Child 2001;85:382-385. 3.Harnden A,Ninis N,Thompson M,Perera R,Leven M,Mant D,Mayon-White R .Parenteral penicillin for children with meningococcal disease before hospital admission: case control study.BMJ2006;332:1295-8. 4.Hahne S J M,Charlet A, Purcell B,Samuelsson S,Camaroni I, Ehrhard I et al.Effectiveness of antibiotics given before admission in reducing mortality from meningococcal disease: systematic review.BMJ 2006;332:1299- 301. Competing interests: None declared