Pre-hospital antibiotic treatment of meningococcal disease: scope for improvement

To determine the extent to which Auckland general practitioners (GPs) follow Ministry of Health guidelines recommending the administration of pre-hospital antibiotic treatment to suspected cases of meningococcal disease.

Retrospective audit of notified cases of meningococcal disease referred by Auckland GPs from 1 May 2001 to 30 April 2002.

Of 142 meningococcal disease cases that were referred to hospital by GPs, 111 (78%) were 'eligible' or met Ministry of Health guideline criteria for pre-hospital antibiotic treatment. Of these, only 33 (30%) were given parenteral antibiotics. Those with a rash were twice as likely as those without a rash to receive antibiotics (RR 2.1; 95% CI 1.7-2.7). There was no difference in antibiotic administration by age, sex, ethnicity, or where there was an estimated delay of greater than 30 minutes to assessment in hospital.

The findings of this audit reinforce the need for GPs to have a higher index of suspicion and lower threshold for treatment for suspected cases of meningococcal disease and to give antibiotics more often than they do at present.