General practitioners worry about seeing—and even more about missing—meningococcal disease. We know that affected children can deteriorate very rapidly and that the disease has a high mortality. And we know that if we suspect this diagnosis we should give parenteral penicillin while arranging urgent transfer to hospital. This is the advice in the British National Formulary, the Drug and Therapeutics Bulletin, and the guidelines for general practitioners from the Meningitis Research Foundation.1

It stands to reason that in a rapidly progressive bacterial infection the earliest possible administration of antibiotics should have a beneficial effect on outcomes. We carry the penicillin in our bags. But not everything that stands to reason proves to be the case—and the uncertainty of the evidence base for prehospital administration of penicillin in suspected meningococcal disease is added to by a paper published in this week's BMJ.2

This study (p 1295) is one of a series reporting a large national case-control study of the clinical management of 448 children aged 0-16 presenting between 1997 and 1999 with meningococcal disease. It compares fatal and non-fatal cases. Previous papers have identified early symptoms of sepsis that medical …