A5V4d

Suspected meningococcal disease
Management by the paediatric specialist
The management of individual serious illnesses is strictly beyond the scope of this guideline.
However, the GDG did come across evidence from the literature searches that they felt should be
included in the guidance. The use of fluids for resuscitation in meningococcal disease is discussed in
section 8.5 above.
Narrative evidence
Evidence for the use of immediate parenteral antibiotics is presented in Sections 9.3. An EL 2+ 11
case–control study on the provision of health care for survivors and those who subsequently died
from meningococcal disease was discussed earlier. In this study, 11 the failure to recognise disease
complications, particularly in the absence of specific paediatric care, was associated with an 8.7-fold
increase in the risk of death (P = 0.002). Not being under the care of a paediatrician was associated
with a 66-fold increase (P = 0.005), failure of supervision a 19.5-fold increase (P = 0.015) and failure
to administer inotropes a 23.7-fold increase (P = 0.005) in the risk of death. Not being under
paediatric care was also highly correlated with a failure to recognise complications (P = 0.002;
Fisher’s exact test).
Evidence summary
In meningococcal disease, the evidence cannot conclude whether or not parenteral antibiotics given
before admission have an effect on case fatality. However, the data are consistent with benefit when
a substantial proportion of cases are treated. Failure to recognise complications of the disease
increases the risk of death, as does not being under the care of a paediatric specialist.
GDG translation
The GDG noted that meningococcal disease is the leading cause of mortality among infectious
diseases in childhood. Children with meningococcal disease may benefit from immediate parenteral
antibiotics, especially if most children with meningococcal disease are treated. The GDG considers
that there is insufficient evidence of effectiveness or cost-effectiveness to change the current UK
practice, which is to give parenteral antibiotics at the earliest opportunity. The GDG also recognises
the importance of children with meningococcal disease being under the care of an experienced
paediatric specialist. The GDG noted the need to anticipate complications.
Recommendations
Number Recommendation
Suspected meningococcal disease
74 Give parenteral antibiotics to children with suspected meningococcal disease at the
earliest opportunity (either benzylpenicillin or a third-generation cephalosporin).
[2007]
75 Children admitted to hospital with meningococcal disease should be under
paediatric care, supervised by a consultant and have their need for inotropes
assessed. [2007]
191