A primary care perspective of meningococcal disease

It is generally agreed that pre-admission benzyl penicillin improves the outcome in infection by Neisseria meningitidis. Even so, only a minority of cases in Birmingham received such treatment. The aim of this study was, therefore, to determine the views of general practitioners (GPs) in Birmingham on the early management of meningococcal disease, including the use of parenteral antibiotics.

A standard semi-structured confidential questionnaire was posted to GPs on the list of Birmingham Family Health Services Authority. The questions covered the GPs' clinical experience of meningococcal infection and their views on the pre-hospital management of suspected cases of Neisseria meningitidis.

Completed questionnaires were received from 372 GPs, a response rate of 70 per cent. Nearly all GPs said they carried benzyl penicillin in their on-call bag (353; 95 per cent) and would give it to a patient they suspected had meningococcal disease (361; 97 per cent). A total of 208 GPs (56 per cent) would not give parenteral chloramphenicol to a patient they suspected had meningococcal disease and a penicillin allergy, and only 25 (7 per cent) carried it as an alternative antibiotic. The most common reason for not giving chloramphenicol was unfamiliarity with dosages (132; 63.5 per cent).

The vast majority of GPs in Birmingham would apparently give benzyl penicillin to a patient they suspected had meningococcal infection. No single issue emerged to explain why pre-admission administration of benzyl penicillin was so low. Further work is being carried out locally to help translate positive attitudes into a change in behaviour.