Improving promptness of antibiotic treatment in meningococcal disease

Objectives-Delays in parenteral antibiotic treatment may contribute to the high mortality in meningococcal disease. This study aimed to record "door t o needle" time in children with meningococcal disease before and after the introduction of a specific teaching programme about the disease. Methods-"Door to needle" time in 33 children with meningococcal disease, ad mitted June 1995-December 1996, were studied. Regular teaching sessions enc ouraging prompt treatment were started in January 1997. "Door to needle" ti me was then studied for 42 children admitted January 1997-December 1998. Results-More of the second cohort attended accident and emergency (A&E) dir ectly (9 of 33 v 24 of 42; p=0.01) rather than being referred by a GP. Simi lar proportions received pre-admission antibiotics from a GP (8 of 24 v 5 o f 18). Mortality was similar in the two groups (2 of 33 v 5 of 42). "Door t o needle" time was significantly shorter in the second cohort in those with a typical rash (median 60 minutes v 18 minutes; p=0.0004). Only 1 of 23 (4 %) children in the second cohort with a typical, petechial rash waited more than 60 minutes for antibiotics, compared with 6 of 24 in the first cohort (p=0.06). Conclusions-Significant improvements in "door to needle" time in meningococ cal disease can be achieved when awareness is heightened by regular teachin g. Those with a typical, petechial rash can be treated within 60 minutes of arrival. Strategies to improve immediate treatment of meningococcal diseas e should include education of A&E staff, especially as an increasing propor tion of cases present directly to A&E.