HOW LONG IS TOO LONG - DETERMINING THE EARLY MANAGEMENT OF MENINGOCOCCAL DISEASE IN BIRMINGHAM

Objective: To determine the length of time cases of meningococcal dise ase wait before receiving parenteral antibiotic therapy in hospital. M ethod: The hospital case notes of residents of Birmingham who were adm itted to local hospitals in 1993 and discharged with a diagnosis of me ningitis or meningococcal disease were reviewed. This information was combined with that held by the West Midlands Ambulance Service. Result s: Forty out of the 82 patients (49%) who met the case definition had meningococcal infection. Twenty one patients (26%) were admitted by am bulance, 11 of whom had meningococcal infection. The mean time from a request for an ambulance to the patient reaching hospital was 52 min f or those with meningococcal infection compared to 55 min for those wit hout. Nineteen patients (47.5%) with meningococcal infection waited mo re than one hour after admission for antibiotic treatment. Seven had a n initial diagnosis of meningitis or meningococcal infection. Ten out of 27 patients with a meningococcal rash (37%), 13 out of 22 patients aged under five years (59%) and 13 out of 24 patients with microbiolog ically confirmed meningococcal infection (54%) waited more than one ho ur for treatment. Seven patients with meningococcal infection received benzyl penicillin before admission. Six received hospital antibiotic treatment within the hour. Conclusion: The assumption that patients su spected of having meningitis or meningococcal disease are treated prom ptly once in hospital is not always correct. The results of this study reinforce the need for all doctors to give benzyl penicillin promptly to patients they suspect have meningococcal disease.