Antibiotics carried in general practitioners' emergency bags: four years onBMJ 1995; 310 doi: https://doi.org/10.1136/bmj.310.6971.29 (Published 07 January 1995) Cite this as: BMJ 1995;310:29
- M J Colbridge, registrara,
- G G Baily, senior registrarb,
- E M Dunbar, consultantb,
- E L C Ong, consultanta
- a Infectious Diseases Unit, University of Newcastle Medical School, Newcastle General Hospital, Newcastle upon Tyne NE4 6BE
- b Department of Infectious Diseases and Tropical Medicine, North Manchester General Hospital, Manchester M8 6RB
- Correspondence to: Dr Ong.
- Accepted 30 June 1994
In 1988 we found in a survey of 115 general practitioners that fewer than half of them carried parenteral penicillin in their emergency bags.1 Since then there has been much publicity and education among doctors about the role of treating patients early with antibiotics to reduce mortality from bacterial meningitis.2 3 4 We therefore carried out a similar survey in north west England, where the original survey was conducted, and in the north east to assess whether measures suggested since our first study had affected the range of antibiotics that general practitioners carry in their emergency bags.
Methods and results
During November and December 1992 we sent all registered general practitioners in north east and north west England (n=3724) a one page questionnaire containing lists of common antibiotics. They were asked to tick those antibiotics that they kept in their bags (questionnaire is available from ELCO). The survey was anonymous, and a stamped addressed envelope was enclosed. No reference was made to the use of early parenteral benzylpenicillin in meningococcal infection.
In all, 70.8% of the questionnaires were returned (69.1% from the north west and 73.0% from the north east). A total of 85.3% of general practitioners carried parenteral benzylpenicillin in their emergency bags (80.1% in the north west and 91.4% in the north east). The mean number of antibiotics carried by general practitioners was six (range 0–12) in the north east and five (0–10) in the north west. The most common antibiotic carried in the north west was oral erythromycin (86.4%) and in the north east was parenteral benzylpenicillin (91.4%). The two most commonly carried oral antibiotics in the north east were amoxycillin (89.3%) and erythromycin (86.7%). Overall, erythromycin was the commonest antibiotic (86.6%) carried, with amoxycillin (86.2%) the second commonest. The table shows the full results of the survey.
We are encouraged by the appreciable increase in the number of general practitioners who carried parenteral benzylpenicillin in their emergency bags compared with the number in our study in 1988. This rise probably reflects increasing awareness by general practitioners of meningococcal disease and of the importance of giving parenteral benzylpenicillin, particularly in the presence of haemorrhagic rash. A publicity campaign conducted among general practitioners in the north east in October 1991 may explain the high percentage of general practitioners in that region carrying benzylpenicillin compared with general practitioners in the north west. The number of general practitioners carrying amoxycillin instead of ampicillin had increased notably since 1988, probably because of the former's better bioavailability and eight hourly dosing regimen, which should increase compliance. Cefaclor was the most popular cephalosporin, and the number of general practitioners carrying ciprofloxacin had increased. Half of the general practitioners still carried co-trimoxazole.
Although the antibiotics carried in the emergency bags do not necessarily reflect general practitioners' prescribing choices, each general practitioner must decide which drugs are the most appropriate for dealing unaided with his or her practice's emergencies. Considerations such as the location and size of the area served by the practice, the distance to the nearest hospital, the availability of casualty services and pharmacists, and likely ambulance response times all help general practitioners to determine what drugs and equipment are needed for the practice and how usefully they can be distributed between the emergency bag, the boot of the car, and the surgery. A parenteral penicillin in our view is essential as evidence increasingly suggests that early treatment with penicillin and prompt referral to hospital results in reduced mortality from meningococcal disease, particularly in septicaemic patients, and we will continue to urge our colleagues in general practice to give parenteral penicillin to all patients with suspected meningococcal disease.
We thank the National Meningitis Trust and Mr Graham Wood, Glaxo Laboratories, for their help and all the general practitioners who participated in the study.