OUTCOME OF PREHOSPITAL ANTIBIOTIC-TREATMENT OF MENINGOCOCCAL DISEASE

Objective: To assess the effect of pre-hospital antibiotic treatment g iven by general practitioners to patients with meningococcal disease. Design: A 16-year population-based historical follow-up study based on referral letters and hospital records in the County of North Jutland, Denmark. Subjects: 320 patients with meningococcal disease, of whom 3 02 were examined by a general practitioner before admission to hospita l. Main outcome measures: Death. Results: 44 patients (14.6%) were giv en antibiotic treatment by the referring general practitioner. Nine of these (20.5%) died, compared with 16 (6.2%) patients who did not rece ive pre-hospital antibiotic treatment. The presence of skin bleeding, petechiae, and impaired consciousness were strongly associated with ca se fatality. Even after adjustment for these variables the odds ratio (OR) for death in patients treated with antibiotics was high (OR = 3.2 ; 95% CI, 0.9-10.6). In the 15 patients with skin bleeding (ecchymoses , suggillations) the case fatality rate was 100% in patients treated w ith antibiotics, and 50% in patients who did not receive antibiotics b efore hospitalization. If skin bleeding was replaced in the models by the presence of disseminated intravascular coagulation on admission, t he OR for death in patients with pre-hospital antibiotic treatment was 35.9 (95% CI, 2.9-441.8) in the presence of disseminated intravascula r coagulation and 1.9 (95% CI, 0.2-19.5) in its absence. Conclusions: Pre hospital treatment is mainly given to the most severe cases with e xpected high case fatality, and this confounding by indication was pro bably not fully adjusted for with the available data. The results cont radict previous findings but provide reason to doubt the benefit of pr e-hospital antibiotic treatment in patients with meningococcal disease . J CLIN EPIDEMIOL 51;9:717-721, 1998. (C) 1998 Elsevier Science Inc.