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Cited by 265Bacterial Infections and VaccinesBacterial Identification and Susceptibility TestingStreptococcal Infections and Treatments

Early treatment with parenteral penicillin in meningococcal disease.

Open access
Cartwright, K., Reilly, S., White, D., Stuart, J.·1992·BMJ
DOI 10.1136/bmj.305.6846.143PMC PMC1883180
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Abstract

OBJECTIVE: To measure the effect of parenteral antibiotics given before admission to hospital on mortality and on bacteriological investigations in meningococcal disease. DESIGN: Retrospective review of hospital notes and laboratory and public health medicine department records. SETTING: Three health districts in south west England. SUBJECTS: Patients with meningococcal disease in Gloucester district presenting between 1 January 1982 and 31 December 1991 (n = 190); patients with meningococcal disease in Plymouth (n = 118) and Bath (n = 73) districts presenting between 1 January 1988 and 31 December 1991 (total = 381). MAIN OUTCOME MEASURE: Number of deaths from meningococcal disease. RESULTS: Parenteral antibiotic given by general practitioners was associated with a substantial reduction in mortality (from 9% to 5%; relative risk 0.6, 95% confidence interval 0.2 to 1.5); patients with a rash were more likely to be given parenteral antibiotics, and mortality was further reduced (from 12% to 5%; 0.5, 0.2 to 1.4). In a district where such treatment was regularly encouraged its use increased from 5% to 40% of cases over 10 years (p = 0.00001). Treatment with parenteral antibiotics before admission made isolation of meningococci from blood and cerebrospinal fluid less likely but did not affect nasopharyngeal cultures. CONCLUSIONS: General practitioners should carry benzylpenicillin in their emergency bags at all times and should administer it promptly, preferably intravenously, whenever meningococcal disease is suspected, unless the patient has had an anaphylactic reaction to penicillin. Specimens for culture should include a nasopharyngeal swab.

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  • Delays in CSF testing can have significant clinical consequences if therapy is delayed or incorrectly administered.

    “This leads to delays, which can have significant clinical consequences if therapy is delayed or incorrectly administered (9–11).”

    From Multicenter Evaluation of BioFire FilmArray Meningitis/Encephalitis Panel for Detection of Bacteria, Viruses, and Yeast in Cerebrospinal Fluid Specimens (2016) · cites this paper as [11]

    The Introduction links diagnostic or therapeutic delay in meningococcal disease to higher mortality, and the section on antibiotics before admission warns that delaying treatment to confirm a diagnosis can be fatal. The paper does not establish that delays in CSF testing cause treatment delays, or that incorrectly administered therapy has the stated clinical consequences. The indexed passages provide section labels but no page numbers. (LLM, conf=0.86)

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1 of the 40 references couldn’t be matched to a known paper.

Research works printed but not linked: 2

  1. Harvey IM, Palmer SR, Peters TJ. Meningitis: can we trust the statistics? Health Trends 1989;21:73-6.
  2. Department of Health and Social Security. Meningococcal infection: meningitis and septicaemia. London: DHSS, 1988. (PL/CMO(88)2.) 19 Drugs for the doctor's bag 1989. Drug Ther Bull 1989;27:17-9.

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Authors
Cartwright, K., Reilly, S., White, D., & Stuart, J.
Affiliations
Gloucestershire Royal Hospital (GB)
ORCID
Reilly, S.
Venue
BMJ
Publisher
BMJ
Published
1992-07-18
Volume
305
Issue
6846
Pages
143-147
ISSN
  • 0007-1447 (ISSN-L)
  • 0959-8138
  • 1468-5833
DOI
10.1136/bmj.305.6846.143
PMC
PMC1883180
OpenAlex
W2049273725
Cited by
265
References
40
Citations by year
2026: 1 · 2025: 1 · 2023: 2 · 2020: 1 · 2019: 4 · 2018: 3 · 2017: 3 · 2016: 6 · 2015: 2 · 2014: 5 · 2013: 2 · 2012: 5
FWCI
9.12
Type
journal article
Language
en
Open access
Locations
  • BMJ (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • HighWire Press Open Archive (submittedVersion)
Topics
  • Life Sciences › Immunology and Microbiology › Microbiology › Bacterial Infections and Vaccines
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Clinical Biochemistry › Bacterial Identification and Susceptibility Testing
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Streptococcal Infections and Treatments
Keywords
meningococcal disease, penicillin G, mortality, general practitioners, nasopharyngeal culture, cerebrospinal fluid culture, rash
MeSH terms
Humans, Infusions, Parenteral, Meningitis, Meningococcal, Meningococcal Infections, Nasopharynx, Neisseria meningitidis, Patient Admission, Penicillin G, Prognosis, Time Factors, Treatment Outcome, Sepsis

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