Intended for healthcare professionals

Student Research explained

Penicillin and meningococcal disease: case-control study

BMJ 2008; 336 doi: (Published 01 May 2008) Cite this as: BMJ 2008;336:0805215
  1. Amy Davis, Roger Robinson editorial registrar1
  1. 1BMJ

Amy Davis takes you through an observational study that looked at whether penicillin prescribed by a general practitioner before admission to hospital improved children's outcomes

This month's paper

“Parenteral penicillin for children with meningococcal disease before hospital admission: case-control study” by Anthony Harnden and colleagues (BMJ 2006;332:1295-8; doi: 10.1136/bmj.38789.723611.55). You can read and see responses to it by going to and clicking on the link.


  • Objective—To explore the impact on mortality and morbidity of parenteral penicillin given to children before admission to hospital with suspected meningococcal disease.

  • Design—Retrospective comparison of fatal and non-fatal cases.

  • Setting—England, Wales, and Northern Ireland; December 1997 to February 1999.

  • Participants—158 children aged 0-16 years (26 died, 132 survived) in whom a general practitioner had made the diagnosis of meningococcal disease before hospital admission.

  • Results—Administration of parenteral penicillin by general practitioners was associated with increased odds ratios for death (7.4, 95% confidence interval 1.5 to 37.7) and complications in survivors (5.0, 1.7 to 15.0). Children who received penicillin had more severe disease on admission (median Glasgow meningococcal septicaemia prognostic score 6.5 v 4.0, P=0.002). Severity on admission did not differ significantly with time taken to reach hospital.

  • Conclusions—Children who were given parenteral penicillin by a general practitioner had more severe disease on reaching hospital than those who were not given penicillin before admission. The association with poor outcome may be because children who are more severely ill are being given penicillin before admission.

Meningococcal infection can be fatal in hours, and a delay in treatment can lead to excess mortality and morbidity. In the UK general practitioners follow guidelines that say they should give parenteral penicillin as soon as possible if they suspect meningococcal disease. But some studies have shown that giving antibiotics early can increase mortality. This study attempts to …

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