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Published on: February 10, 2011
Antibiotic treatment of children with unsuspected meningococcal disease
V J Wang1, R Malley, G R Fleisher
1Department of Medicine, Children's Hospital, Boston, Mass 02115, USA.
Background:
Data from an earlier study suggest that patients with unsuspected meningococcal disease (UMD) cannot be differentiated easily from febrile children with viral syndromes on the basis of physical examinations or peripheral blood counts. Some children with meningococcal disease therefore are treated inadvertently as outpatients.
Objective:
To determine whether antibiotic therapy administered at the outpatient visit prevents complications, permanent sequelae, or death in children with UMD.
Methods:
We reviewed the medical records of patients younger than 20 years with invasive meningococcal disease at 7 pediatric referral centers from January 1, 1981, through December 31, 1996. Patients were considered to have UMD if they underwent evaluation and discharge as outpatients and if blood and/or cerebrospinal fluid cultures obtained at evaluation yielded Neisseria meningitidis. We compared the frequency of development of complications (meningitis, sepsis, and pericarditis), permanent sequelae (limb amputation, skin grafting, and persistent neurologic disability) or death between patients who did and did not receive antibiotics at the outpatient visits.
Results:
Of 58 children with UMD, 19 (33%) received antibiotics and 39 (67%) did not. Complications occurred significantly less frequently in the antibiotic-treated group (7/19 [37%] vs 27/39 [69%]; odds ratio [OR], 0.26; 95% confidence interval [CI], 0.08-0.81; P = .03). There was no significant difference in death or permanent sequelae between groups (0/19 vs 3/39 [8%]; OR, 0; 95% CI, 0-2.61; P=.54). There was insufficient power, however, to exclude the possibility of a clinically meaningful difference between the groups with regard to these latter outcomes.
Conclusions:
Antibiotic administration to young patients with UMD at the time of the outpatient visit is associated with a reduction in complications from this disease. Although the routine use of antibiotics in febrile outpatients younger than 20 years cannot be advocated, empirical treatment should be considered in the setting of higher probability of meningococcal disease.
Insights
Antibiotic treatment for children with unsuspected meningococcal disease (UMD) significantly reduced complications. Empirical antibiotic therapy may be considered for febrile children with a higher probability of meningococcal disease.
Area of Science:
- Pediatric infectious diseases
- Bacteriology
- Clinical pharmacology
Background:
- Unsuspected meningococcal disease (UMD) in children is difficult to distinguish from viral illnesses based on initial clinical presentation and lab results.
- Some children with UMD are initially treated as outpatients, potentially delaying appropriate care.
Purpose of the Study:
- To evaluate if antibiotic therapy given during an outpatient visit prevents complications, long-term sequelae, or death in children diagnosed with UMD.
Main Methods:
- Retrospective review of medical records for 58 pediatric patients (under 20 years) diagnosed with invasive meningococcal disease between 1981-1996.
- UMD was defined as patients evaluated and discharged as outpatients with positive blood or cerebrospinal fluid cultures for Neisseria meningitidis.
- Comparison of complication rates, permanent sequelae, and mortality between UMD patients who received antibiotics at the outpatient visit versus those who did not.
Main Results:
- Of 58 UMD patients, 19 received outpatient antibiotics and 39 did not.
- Complications were significantly less frequent in the antibiotic-treated group (37% vs. 69%, OR 0.26, P=.03).
- No significant difference was observed in death or permanent sequelae between groups (8% in untreated), though the study lacked power to detect smaller differences.
Conclusions:
- Antibiotic administration during outpatient visits for UMD is linked to fewer complications.
- Routine antibiotic use in all febrile outpatients is not recommended, but empirical treatment should be considered when meningococcal disease is suspected.
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