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Effectiveness of antibiotics given before admission in reducing mortality from meningococcal disease: systematic review

BMJ 2006; 332 doi: (Published 01 June 2006) Cite this as: BMJ 2006;332:1299
  1. Susan J M Hahné (susan.hahne{at}, medical epidemiologist1,
  2. André Charlett, interim director2,
  3. Bernadette Purcell, consultant in communicable disease control3,
  4. Susanne Samuelsson, medical epidemiologist4,
  5. Ivonne Camaroni, medical doctor5,
  6. Ingrid Ehrhard, medical microbiologist6,
  7. Sigrid Heuberger, head7,
  8. Maria Santamaria, medical officer8,
  9. James M Stuart, regional director9
  1. 1 National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands,
  2. 2 Statistics, Modelling and Bioinformatics Department, Centre for Infections, Health Protection Agency, London,
  3. 3 Sussex Health Protection Unit, Health Protection Agency, Lewes, East Sussex,
  4. 4 Statens Serum Institut (SSI), Copenhagen, Denmark,
  5. 5 Department of Epidemiology, Smittskyddsinstitutet (SMI), Stockholm, Sweden,
  6. 6 Public Health Laboratory of Saxony, Dresden, Germany,
  7. 7 Austria National Reference Centre for Meningococci, Austrian Agency for Food and Health Safety, Graz, Austria,
  8. 8 WHO, Communicable Disease Surveillance and Response (CSR), Geneva, Switzerland,
  9. 9 Health Protection Agency South West, Stonehouse, Gloucestershire
  1. Correspondence to: S Hahné
  • Accepted 10 May 2006


Objective To review the evidence for effectiveness of treatment with antibiotics before admission in reducing case fatality from meningococcal disease.

Design Systematic review.

Data sources Cochrane register of trials and systematic reviews, database of abstracts of reviews of effectiveness, health technology assessment, and national research register in England and Wales, Medline, Embase, and CAB Health.

Included studies Studies describing vital outcome of at least 10 cases of meningococcal disease classified by whether or not antibiotics were given before admission to hospital.

Results 14 observational studies met the review criteria. Oral antibiotic treatment given before admission was associated with reduced mortality among cases (combined risk ratio 0.17, 95% confidence interval 0.07 to 0.44). In seven studies in which all included patients were seen in primary care, the association between parenteral antibiotics before admission and outcome was inconsistent (χ2 for heterogeneity 11.02, P = 0.09). After adjustment for the proportion given parenteral antibiotics before admission, there was no residual heterogeneity. A higher proportion of patients given parenteral antibiotics before admission was associated with reduced mortality after such treatment and vice versa (P = 0.04).

Conclusion Confounding by severity is the most likely explanation both for the beneficial effect of oral antibiotics and the harmful effect observed in some studies of parenteral antibiotics. We cannot conclude whether or not antibiotics given before admission have an effect on case fatality. The data are consistent with benefit when a substantial proportion of cases are treated.


  • Competing interests None declared.

  • Ethical approval: Not required.

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