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

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Early treatment with parenteral penicillin in meningococcal disease.

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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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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: bronze
doi.org
Locations: BMJ (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
HighWire Press Open Archive (submittedVersion)
Topics: Life Sciences › Immunology and Microbiology › Microbiology › Bacterial Infections and Vaccines
Health Sciences › Medicine › Microbiology (medical) › Bacterial Identification and Susceptibility Testing
Health Sciences › Medicine › Infectious Diseases › 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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Early treatment with parenteral penicillin in meningococcal disease.

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