Pre-hospital antibiotics and preventing deaths from meningitis and septicaemia
02 June 2006
Findings from a large national study funded by Meningitis Research Foundation and published today in the BMJ describe the impact of pre-hospital penicillin given by GPs to children with meningococcal disease (meningitis and septicaemia).
Since 1988, the Chief Medical Officer has published advice to GPs to give penicillin to patients with suspected meningococcal disease before sending them to hospital, and Meningitis Research Foundation's resources for GPs support this advice.
In this study, researchers from Imperial College London, Oxford, and the Royal College of Paediatrics and Child Health (RCPCH) found that GPs were more likely to give penicillin to severely ill children than to those with less severe disease. Not surprisingly, the death rate was higher in children receiving penicillin, as they were already critically ill by the time they were treated. GPs recognise the need for urgent treatment in the sickest children, but many less advanced cases go unrecognised and are not offered early antibiotics.
We know that, once in hospital, the sooner antibiotics are given, the better the outcome, but previous studies show conflicting evidence of the effect of pre-hospital antibiotics.
A review published in this issue of the BMJ explains this in more detail. Looking at all previously published studies of pre-hospital antibiotics, most studies found a beneficial effect from pre-hospital antibiotics, but in a few studies, the effect was detrimental. Again, the results were confounded by severity of illness-a doctor's perception of how ill the patient was influenced his or her decision to give antibiotics. However, the authors showed that where a high proportion of patients with suspected meningococcal disease were treated with pre-hospital antibiotics, the effect was beneficial.
This research highlights the importance of improving early recognition and treatment of suspected meningitis and septicaemia so that more patients are diagnosed, and antibiotics given when their doctor first sees them. The longer the illness goes undetected the sicker the patient gets, and in patients who are already severely ill, pre-hospital penicillin may be too late to prevent death in some cases. Previous research from the Foundation's national study found that almost 50% of children presenting to their GP with meningococcal disease were not diagnosed on their first visit, but were sent home.
Meningitis Research Foundation Chief Executive Denise Vaughan commented: "This research funded by the Foundation shows that the later treatment starts, the harder it is for doctors to save a life. Public and health professional awareness of the signs and symptoms is key to an early diagnosis and prompt effective treatment."
Read more about this project:
Research Archive for the public - Health care delivery and outcome: a confidential enquiry into meningococcal disease in children
Research Archive for the scientific community - Health care delivery and the outcome of meningococcal disease in children
Media Contact: Julia Warren, Prof Mike Levin, Dr Nelly Ninis 01454 281811 or 07711 057875
Notes to Editor:
- The study the Foundation funded took place in England, Wales and Northern Ireland. The families of 544 children under age 17 who contracted meningococcal meningitis and septicaemia between December 1997 - February 1999 agreed to participate, and the study focused on the 158 children in whom the disease was diagnosed by their GP.
- Paediatricians at Imperial College London under the auspices of the Royal College of Paediatrics and Child Health undertook the study. Analysis of the data involved researchers at the University of Oxford funded by the Medical Research Council.
- This Foundation-funded study, and the review of pre-hospital antibiotics are the subject of an editorial in this issue of the BMJ.
- Meningitis Research Foundation is a national registered charity currently funding 21 research projects in the UK and internationally to a total value of in excess £2.5 million, and has by far the largest commitment of any meningitis charity.
- Meningitis Research Foundation has developed symptoms information for the general public.
- Meningitis Research Foundation has developed resources for health professionals to help with diagnosis and treatment of meningitis and septicaemia.
- Meningitis Research Foundation operates a Freefone 24 hour helpline - 080 8800 3344 - providing information on meningitis and septicaemia to the general public and health professionals.
- Information on meningitis and septicaemia is also available on the Foundation's world-renowned website - www.meningitis.org- in 18 languages. An interpretation service in 120 languages is available through the 24 hour helpline.
- Meningitis Research Foundation received a grant from The National Lottery Charities Board (now the Big Lottery Fund) which enabled support for part of this study.
Symptoms of meningitis:
Severe headache; stiff neck*; dislike of bright lights*; fever; vomiting; drowsy and less responsive/vacant; rash; seizures (fits) may also be seen. (*Unusual in young children.)
Symptoms of septicaemia (blood poisoning form of the disease):
Rash; fever; vomiting; cold hands and feet; pale or mottled skin; limb/joint/muscle pain; rapid or unusual breathing; shivering; abdominal pain (sometimes with diarrhoea); drowsy and less responsive/vacant.
Other symptoms in babies include:
tense or bulging fontanelle (soft spot); blotchy skin, getting paler or turning blue; refusing to feed; being irritable when picked up with a high pitched or moaning dry; a stiff body with jerky movements or else floppy and lifeless.