Pre-hospital penicillin ‘may harm’ children with meningitis

Administering antibiotics to children diagnosed with meningitis before they reach hospital may in fact be harming patients rather than helping them to survive, two new studies suggest.

Two reports published today in the British Medical Journal claim that parenteral (injected) penicillin is increasing child death rates from meningitis, yet it is still standard practice in many European countries ? including the UK.

The first study was conducted by a UK-based team of researchers and analysed 158 children diagnosed with suspected meningococcal disease by their GPs. It found the two-thirds of the children that were given a pre-hospital treatment of parenteral penicillin in accordance with official guidelines were more likely to die before reaching hospital.

However, the study authors highlighted the fact that GPs were more inclined to administer antibiotics to children suffering from the most severe cases of meningitis, which could explain why a higher proportion died.

An international group of researchers is responsible for the second report, which drew statistical evidence from 14 studies in total. It discovered that just as there is a correlation between injected penicillin and increased death rates among children suffering from meningitis, orally taken antibiotics are associated with a reduction in mortality rates.

But the research team again admit that this is partly attributable to GPs choosing to administer oral penicillin in only the milder cases of meningitis.

“We cannot conclude from this review whether or not antibiotics given before admission have an effect on case fatality, though the data are consistent with benefit when a substantial proportion of cases are treated,” the authors comment.

Both studies agree that early diagnosis by parents and GPs is a considerable factor in deciding whether children will survive meningitis, as is a rapid transfer to hospital.

The Meningitis Research Foundation has said it will consider the implications of the two separate reports.

The effects of meningitis and the associated septicaemia can be fatal within hours of the disease being contracted.

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