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Penicillin use in meningitis 'may harm'

by Emma Wilkinson

GP administration of penicillin injections before sending children with suspected meningococcal disease to hospital may be of no benefit and could even be harmful.

A new GP study found parenteral penicillin appeared to increase the risk of complications or death seven-fold ­ even after adjusting for disease severity.

The researchers, whose study will shortly be published in the BMJ, said it might be more important to rush children to hospital than to worry about injecting them with penicillin.

Study leader Dr Anthony Harnden, senior lecturer at the department of primary health care at the University of Oxford and a GP in Wheatley, Oxfordshire, said the study had important medicolegal implications.

'Children who are given penicillin are likely to be severely ill. But the more we adjusted for it the more it seemed to be associated with harm. We can only conclude there is no evidence penicillin has any benefit and at worst it may do harm.'

He added: 'It's important from a legal point of view. If a GP decided not to give penicillin but rush the child straight to hospital, they may have managed them well but they could be culpable if the child died.'

He said the most plausible biological explanation was that penicillin was sending children into shock by stimulating the release of endotoxins.

'There's no doubt penicillin is the treatment of choice, but it might be best to give it in hospital. I don't think one study can change national policy but it can call it into question.'

Dr Brian Crichton, a GP in Solihull and lecturer in therapeutics and pharmacology at the University of Warwick, said although the findings were paradoxical they were plausible. 'It needs further research but it's important we sort this out.'

The study looked at 158 children aged 0 to 16 years diagnosed with meningococcal disease by a GP before reaching hospital, of whom 105 were given penicillin and 47 were not.

Meningitis litigation costs

· 2 per cent of all GP files opened in last five years involve meningococcal disease, with MDU receiving average of one new notification a week

· Settlements are higher than for any other category of claim, ranging from over £1,000 to in excess of £1 million

· Three-quarters involve children under 14 years; by far the most costly involve under-twos

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