Early management of meningococcal disease

Sixty-eight cases of meningococcal disease were ascertained at a district hospital in Wessex region over a four year period. Forty-seven of the 68 patients were reported to have a haemorrhagic rash on admission to hospital, three of whom died. Twelve of the 47 had received parenteral antibiotic treatment before admission, and none of these died. The overall case fatality was 4% (3/68). Sixty-three patients were referred by general practitioners. In 19 of the 63 a haemorrhagic rash was described at referral, and a haemorrhagic rash was described in 42 on hospital admission. Thirteen of the 63 received parenteral antibiotic treatment before admission. Such treatment was significantly more likely when the referral letter described a haemorrhagic rash and appeared to be less likely in child cases and when patients had received earlier oral antibiotics.