A primary care perspective of meningococcal disease

Background It is generally agreed that pre-admission benzyl penicillin impr oves the outcome in infection by Neisseria meningitidis. Even so, only a mi nority of cases in Birmingham received such treatment, The aim of this stud y 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. Methods A standard semi-structured confidential questionnaire was posted to GPs on the list of Birmingham Family Health Services Authority. The questi ons covered the GPs' clinical experience of meningococcal infection and the ir views on the pre-hospital management of suspected cases of Neisseria men ingitidis. Results Completed questionnaires were received from 372 GPs, a response rat e of 70 per cent. Nearly all GPs said they carried benzyl penicillin in the ir on-call bag (353; 95 per cent) and would give it to a patient they suspe cted had meningococcal disease (361; 97 per cent). A total of 208 GPs (56 p er cent) would not give parenteral chloramphenicol to a patient they suspec ted had meningococcal disease and a penicillin allergy, and only 25 (7 per cent) carried it as an alternative antibiotic. The most common reason for n ot giving chloramphenicol was unfamiliarity with dosages (132; 63.5 per cen t). Conclusions The vast majority of GPs in Birmingham would apparently give be nzyl 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 t ranslate positive attitudes into a change in behaviour.