Early treatment with benzylpenicillin is important and doesn't jeopardise diagnosis

The incidence of meningococcal disease in England and Wales has remained at high levels over the past two winters, as has the proportion of cases caused by strains of serogroup C (M Ramsay, E Kaczmarski, personal communications). Clusters, also caused mainly by serogroup C strains, have increased considerably, particularly among students at schools and universities (A Rushdy, J Stuart, personal communications). While effective vaccines are awaited, current priorities are to optimise recognition, diagnosis, and management.

Administration of benzylpenicillin to suspected cases before admission to hospital reduces mortality1 and is advocated by the United Kingdom's chief medical officers. Though now used more widely, continuing failure to implement this simple measure2 may be due to a misplaced fear of obscuring the diagnosis and thereby jeopardising management.

After an injection of benzylpenicillin blood culture is rarely positive and, though cerebrospinal fluid may still yield meningococci,3 lumbar puncture is an increasingly controversial investigation in suspected meningococcal disease. …