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| | Journal Club Take part in the discussion of an article published in the various Medical Journal, Journal club info and more... | | Prehospital parenteral penicillin for children with meningococcal disease | | Prehospital parenteral penicillin for children with meningococcal disease
The authors intended to explore the impact on mortality and morbidity of parenteral penicillin given to children before admission to hospital with suspected meningococcal disease.
Retrospective comparison of fatal and non-fatal cases.
Setting: England, Wales, and Northern Ireland; December 1997 to February 1999.
Participants: 158 children aged 0-16 years (26 died, 132 survived) in whom a general practitioner had made the diagnosis of meningococcal disease before hospital admission.
Results: Administration of parenteral penicillin by general practitioners was associated with increased odds ratios for death (7.4, 95% confidence interval 1.5 to 37.7) and complications in survivors (5.0, 1.7 to 15.0). Children who received penicillin had more severe disease on admission (median Glasgow meningococcal septicaemia prognostic score (GMSPS) 6.5 v 4.0, P = 0.002). Severity on admission did not differ significantly with time taken to reach hospital.
Conclusions: Children who were given parenteral penicillin by a general practitioner had more severe disease on reaching hospital than those who were not given penicillin before admission. The association with poor outcome may be because children who are more severely ill are being given penicillin before admission. | | | | | The Following User Says Thank You to Anil Tuladhar For This Useful Post: | | |
| | Re: Prehospital parenteral penicillin for children with meningococcal disease
This is an excellent example of how statistics can fool clinicians. I don't even believe for a second that anyone with good conscience will stop giving im penicillin after reading this article.
Of course, it won't be difficult to clinically ascertain a meningococcal case in its fulminant form and these children are the ones who prognostically don't do well and are more likely to receive out of hospital im penicillin.
Hence, we don't need rocket science to understand and realise the worst outcome in these cases. So, do not get misled by this article. | |
Last edited by Anil Tuladhar : 03-06-2006 at 01:05 AM.
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By
Soul
on
03-06-2006, 09:28 AM
| | Re: Prehospital parenteral penicillin for children with meningococcal disease
Nice posting. But these results will certainly not affect the medical practice in Nepal coz prehospital disease management is not like that in europe usa. In western countries a patient with ST segment elevation myocardial infarction gets thrombolytic therapy en route ( in ambulance), but in nepal patient must be admitted in CCU. We get afraid of the possible complications. The problem is there is no fix protocol, no facilities and lack of such kind of research works. Who will do? govt is unable to invest in research works, and we can't do independently. | | | | | | Re: Prehospital parenteral penicillin for children with meningococcal disease
The purpose of this club is to make we doctors realise what the best practice is. Noone is more aware than myself who had worked with children in grim circumstances in Nepal for nearly seven years.
If we keep presuming that it won't make any difference to the practice in Nepal by whatever we put up here, I think we should put our pen down and keep praying for things to change for better.
As per Soul's short note on thrombolytic therapy which is also undoubtedly very important and life saving, I think giving im peniciliin which is more readily available can or should make lot of difference by making all health professionals aware of using it in suspected meningococcal cases. | | | | Review Tools | | | | Display Modes |  Linear Mode | 
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