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Parenteral penicillin for children with meningococcal disease before hospital admission: case-control study

Anthony Harnden1, Nelly Ninis, Matthew Thompson

  • 1Department of Primary Health Care, Institute of Health Sciences, University of Oxford, Oxford OX3 7LF. anthony.harnden@dphpc.ox.ac.uk Abstract

BMJ (Clinical Research Ed.)
|March 24, 2006
PubMed

Insights

Pre-hospital penicillin administration in children with suspected meningococcal disease was linked to more severe illness and poorer outcomes. This association may stem from sicker children receiving early penicillin treatment.

Area of Science:

  • Pediatric Infectious Diseases
  • Clinical Pharmacology
  • Epidemiology

Background:

  • Meningococcal disease remains a significant cause of childhood mortality and morbidity.
  • Early intervention with antibiotics is crucial for managing suspected meningococcal disease.
  • The impact of pre-hospital antibiotic administration on disease severity and outcomes requires investigation.

Purpose of the Study:

  • To investigate the association between pre-hospital parenteral penicillin administration and mortality/morbidity in children with suspected meningococcal disease.
  • To evaluate the relationship between early penicillin use and disease severity upon hospital admission.

Main Methods:

  • Retrospective comparative study of 158 children (aged 0-16 years) diagnosed with meningococcal disease by general practitioners before hospital admission.
  • Analysis of fatal (n=26) versus non-fatal (n=132) cases.
  • Comparison of disease severity using the Glasgow meningococcal septicaemia prognostic score (GMSPS).

Main Results:

  • Pre-hospital penicillin administration was associated with significantly increased odds of death (OR 7.4) and complications in survivors (OR 5.0).
  • Children receiving pre-hospital penicillin presented with more severe disease on admission (median GMSPS 6.5 vs. 4.0, P=0.002).
  • Disease severity at admission was not significantly influenced by the time taken to reach the hospital.

Conclusions:

  • Pre-hospital penicillin use in suspected meningococcal disease is associated with more severe illness at hospital presentation.
  • The observed association with poorer outcomes may be attributed to the practice of administering penicillin to more severely ill children prior to hospital admission.
  • Further research is needed to clarify the optimal timing and indications for pre-hospital antibiotic therapy in pediatric meningococcal disease.
Abstract

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