Antimicrobial therapy and case fatality in meningococcal disease.

The effect of different initial antimicrobial treatments on the case fatality rate (CFR) was evaluated in 112 consecutive patients with meningococcal disease. The overall CFR was 9.8%. 85 patients received initial therapy with chloramphenicol in addition to benzylpenicillin or other antimicrobials, and 27 patients benzylpenicillin or other antimicrobials without chloramphenicol. Patients treated with chloramphenicol had a lower CFR than those not given chloramphenicol (5% vs. 26%; p = 0.004). However, severely ill patients were treated more often with penicillins, and adjustment for the severity of disease on admission to hospital demonstrated that this difference in favour of chloramphenicol was slight and nonsignificant (p = 0.58). High doses of benzylpenicillin and no chloramphenicol were also associated with a higher CFR than low doses. However, the difference was not significant (p = 0.22). More extensive studies should be carried out to evaluate the effect of benzylpenicillin doses and chloramphenicol on the outcome of meningococcal disease.