Early treatment of meningococcal disease.

Cartwright, Keith; Strang, J. R.; Gossain, Savita; Begg, Norman

doi:10.1136/bmj.305.6856.774

Cited by 57 publications

(27 citation statements)

References 3 publications

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“…Death at a later stage of illness is still clearly determined by the early course of the disease. In New Zealand, as in some other countries [29,30], it is currently recommended that general practitioners administer parenteral penicillin to all patients with suspected meningococcal disease before hospital admission [23]. In our series, 14 patients (24%) received antibiotics before admission to hospital, and none of these patients died.…”

Section: Discussionmentioning

confidence: 77%

Three Days of Intravenous Benzyl Penicillin Treatment of Meningococcal Disease in Adults

Rb¹,

Galler²,

Roberts

et al. 2003

Clinical Infectious Diseases

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New Zealand has experienced an epidemic of predominantly serogroup B meningococcal disease during the past decade. In a prospective study, we treated adults (age, >15 years) with meningococcal disease with intravenous benzyl penicillin (12 MU [7.2 g] per day) for 3 days. Sixty-one adults with suspected meningococcal disease were consecutively admitted during the 33-month period; 3 patients were excluded. The 58 patients had a mean age (+/- standard deviation [SD]) of 27.9+/-14.5 years (median, 21 years; range, 15-70 years). Forty-four patients had confirmed and 14 patients had probable meningococcal disease. Fifty-seven patients received 12 MU (7.2 g) and 1 received 8 MU (4.8 g) of benzyl penicillin per day. Thirteen patients received additional antibiotics within the first 24 h because of diagnostic uncertainties. Patients received a mean (+/-SD) of 3.0+/-0.5 days of treatment. No patients relapsed. Five patients died. All but 1 death occurred during benzyl penicillin treatment, and the only posttreatment death was not due to meningococcal disease. Three days of intravenous benzyl penicillin is sufficient treatment for adults with meningococcal disease. The usual recommendations for duration of treatment are excessive.

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Section: Discussionmentioning

confidence: 77%

Three Days of Intravenous Benzyl Penicillin Treatment of Meningococcal Disease in Adults

Rb¹,

Galler²,

Roberts

et al. 2003

Clinical Infectious Diseases

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“…17 A rash is a late IMD symptom and was identified in each focus group, yet earlier signs and symptoms (such as very high fever, or cold hands and feet) were not stated. Waiting for late symptoms can increase the risk of poor outcomes 8 ; therefore, further public health education may be required to increase understanding of the early signs and symptoms of IMD.…”

Section: Discussionmentioning

confidence: 99%

“…7 Early diagnosis, treatment and public health management of IMD improve patient outcomes and highlight the need for the public to be aware of the disease. 7,8 Identifying what members of the public understand about IMD and their perceptions of the disease may help to inform better public health practice and reduce risk. This is the first study of its type to explore current understanding, perceptions and feelings of people in higher risk groups about IMD in a regional area of Australia.…”

Section: Introductionmentioning

confidence: 99%

Describing meningococcal disease: understanding, perceptions and feelings of people in a regional area of NSW, Australia

Kohlhagen¹,

Massey²,

Taylor³

et al. 2016

Public Health Res Pr

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Objectives: To explore understanding, perceptions and feelings about meningococcal disease in members of higher risk groups. To explore what people say are the most important health messages and communication preferences about invasive meningococcal disease (IMD). Methods:Three focus groups and two semistructured interviews were conducted with people at higher risk of IMD in Hunter New England Local Health District in New South Wales.Results: Participants generally had a low understanding of IMD, but described intense feelings about the disease and empathy for those who had experienced the disease. Fear of stigma and the impact of stigma were identified. Participants identified reasons for delaying presentation for care as perceptions of invincibility (particularly among young people), the cost of care (for all groups), and racism (particularly for Aboriginal people). These issues were both potential and experienced barriers for participants accessing help when acutely unwell. Factors for effective communication to improve understanding of IMD included the communication being acceptable, accessible and appropriate.Conclusions: IMD is a serious but uncommon disease that has a range of impacts on people, families and communities. Higher risk groups may benefit from receiving more appropriate and accessible information about early signs and symptoms of IMD. Communication and understanding about the disease could be improved by working with new technologies and partnering with key people in high-risk groups. Use of text messages and social networking for urgent communication could be considered and trialled in public health practice. It is also important to recognise the potential direct or indirect experience of racism and stigma for patients with IMD and their families. Management of IMD could be strengthened by connecting people and families with support groups or services to reduce the impact of the disease.

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“…However, it may be difficult to identify a patient with meningococcal meningitis, and it is unclear whether patients benefit from such prehospital treatment. Although retrospective data from the United Kingdom showed a favorable outcome in patients who were treated early with parenteral antibiotics [42], prehospital antibiotic treatment remains controversial. In a Danish study, considerably higher mortality rates were reported in patients with suspected meningococcal meningitis who were pretreated [43].…”

Section: Timing and Durationmentioning

confidence: 99%

Adjunctive corticosteroids in adults with bacterial meningitis

Beek

Gans²

2005

Curr Infect Dis Rep

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Bacterial meningitis is a complex disorder in which neurologic injury is caused, in part, by the causative organism and, in part, by the host's own inflammatory response. In studies of experimental bacterial meningitis, adjuvant treatment with corticosteroids, specifically dexamethasone, has beneficial effects. On the basis of these experimental studies, several clinical trials were undertaken to determine the effects of adjunctive corticosteroids in patients with bacterial meningitis. On the basis of overall benefit without detrimental effects by subgroup analysis, dexamethasone therapy should be initiated before or with the first dose of antibiotic and should be continued in most patients with community-acquired acute bacterial meningitis. For patients with a low suspicion of meningitis but an urgent need for antibiotics before cerebrospinal fluid can be obtained, we recommend initiation of treatment with dexamethasone, with discontinuation of dexamethasone therapy as soon as the diagnosis has been excluded.

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Early treatment of meningococcal disease.

Cited by 57 publications

References 3 publications

Three Days of Intravenous Benzyl Penicillin Treatment of Meningococcal Disease in Adults

Three Days of Intravenous Benzyl Penicillin Treatment of Meningococcal Disease in Adults

Describing meningococcal disease: understanding, perceptions and feelings of people in a regional area of NSW, Australia

Adjunctive corticosteroids in adults with bacterial meningitis

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