Tag Archives: antibiotics

Meningococcus

For Emergency Departments, For General Practitioners,

Had another fatal Meningococcal B case a few weeks ago.  Always upsetting.  Text book management by the night team, excellent support and fast action by CATS retrieval team, the full services of one of the top PICUs in the country – but that horrible little diplococcus won the battle.  Of course it didn’t really, our antibiotics would have killed it off pretty quickly, but the cascade it had set in motion was irreversible.  2 of the juniors involved with the case have separately presented it and looked into aspects of it further – a mark of how deaths like this have an effect on every member of the team.   Dr Keir Shiels looked at prophylaxis and secondary prevention:

Neisseria meningitidis is found in the throats of around 15% of the population and is the cause of the much-feared meningococcal septicaemia. The incidence of meningococcaemia has fallen significantly since the advent of vaccines against some strains; and public awareness of the danger of non-blanching rashes is high.

Despite the relatively high prevalence of N. meningitidis as a commensal organism in the population and the relatively low incidence of meningococcaemia, meningococcal sepsis is still a notifiable disease. This stems from the pre-vaccine days when Men A was able to spread epidemically. The HPA still recommends prophylactic antibiotics for contacts of a patient with meningococcaemia.
 
A recent Cochrane review has been published regarding the effectiveness of different antibiotic regimens in obliterating N. meningitidis from the throats of inoculated hosts. The study has compared the effectiveness of Rifampicin, cefalosporin and Ciproflaxacin and comes to several conclusions which have altered UK HPA Guidelines.
 
The increasing risk of rifampicin-resistant N. meningitidis, plus the reduced likelihood of compliance with a twice daily prophylaxis for two days, means that for adults and older children, rifampicin is no longer the antibiotic of choice. The HPA now recommend ciproflaxacin to be given as a single one-off dose instead. It is believed that this is at least equally effective, but with far better compliance. 
 
People who require prophylaxis remain as: first degree relatives, people sleeping in the same house, classmates and teacher at school.
 
Given the risks of using fluoroquinolones in children, the Cochrane review is circumspect in advising the administration of ciprofloxacin to children. However, the HPA leave it to a paediatrician’s discretion to consider the risks of a single one-off dose and still suggest ciprofloxacin as first line consideration. Rifampicin (2 doses daily for 2 days) is now considered second line.

December PDF for the ED

For Emergency Departments, PDF digests: Emergency Departments, , , , , , ,

This month’s emergency department version of Paediatric Pearls has information on dehydration from the NICE guideline on gastroenteritis in the under 5s, a bit on seizures and the evidence behind our reluctance to let you request chest x-rays for children.  I’ve featured the NICE guideline on antibiotics for respiratory illness in primary care too as they are also relevant for the children we see in EUCC and the Emergency Department.  I hope you find it helpful; I think the average length of time for each infection is useful information to be able to hand on to parents.  Download December’s Paediatric Pearls here.

December 2010 PDF digest for GPs now published!

For General Practitioners, PDF digests: for General Practitioners, , , ,

December’s Paediatric Pearls (GP edition) reminds us all of the NICE guideline on antibiotic prescribing in respiratory tract infections.  I would like to do a bit more of the “delayed prescribing” in the Emergency Department but it would require either the family coming back (ie. a “no antibiotic” policy really) or their putting a bottle of amoxicillin in their fridge and potentially not using it as we give out the actual antibiotic in A and E, not prescriptions.  We’ve also featured a couple of papers showing that chest x-rays add very little to the management of a child with a respiratory illness which I think most GPs know but it doesn’t harm to remind trainees still in the hospital that, just because the radiology department is at the end of the corridor, it doesn’t mean you have to use it!  We continue our 6-8 week baby check series with information on sacral dimples and I have also put in a couple of websites with sensible, empathetic information and advice on school refusal.  The beginning of term is stressful for children who find it hard to go to school and parents may find these sites helpful when trying to understand why their child is behaving in that way.  Happy New Year to you all!