Riordan F A, Thomson A P, Sills J A, Hart C A
Institute of Child Health, University of Liverpool.
J Accid Emerg Med. 1998 Jul;15(4):249-51. doi: 10.1136/emj.15.4.249.
To measure the promptness of antibiotic treatment in children with meningococcal disease.
"Door to needle time" for parenteral antibiotics in children with meningococcal disease was recorded prospectively as part of a larger study. The time from arrival at hospital until the first dose of parenteral antibiotics was recorded in 100 children with meningococcal disease (median (range) age 21 (3-168) months) admitted to four Merseyside hospitals.
Forty five children presented directly to the accident and emergency (A&E) department. Parenteral penicillin was given before admission to 19 of the 55 children referred by general practitioners (GPs). Median door to needle time was 36 minutes. All children with a typical petechial rash on arrival received antibiotics within 60 minutes. Antibiotics were given sooner to those with severe disease (p = 0.01) and later to those without a rash (p = 0.007).
The first dose of parenteral antibiotics for most children with meningococcal disease was given in A&E. When awareness of meningococcal disease is heightened by ongoing research, those with a petechial rash are treated within 60 minutes. Strategies to improve immediate treatment of meningococcal disease should include education of A&E staff as well as GPs.
测定脑膜炎球菌病患儿抗生素治疗的及时性。
作为一项更大规模研究的一部分，前瞻性记录了脑膜炎球菌病患儿接受胃肠外抗生素治疗的“入院至用药时间”。记录了默西塞德郡四家医院收治的100例脑膜炎球菌病患儿（年龄中位数（范围）为21（3 - 168）个月）从入院到首次使用胃肠外抗生素的时间。
45名患儿直接前往急诊部就诊。在全科医生转诊的55名患儿中，有19名在入院前就接受了胃肠外青霉素治疗。入院至用药时间的中位数为36分钟。所有入院时出现典型瘀点疹的患儿在60分钟内均接受了抗生素治疗。病情严重的患儿抗生素给药时间更早（p = 0.01），无皮疹的患儿给药时间更晚（p = 0.007）。
大多数脑膜炎球菌病患儿的首剂胃肠外抗生素是在急诊部给予的。当通过持续研究提高对脑膜炎球菌病的认识时，出现瘀点疹的患儿会在60分钟内接受治疗。改善脑膜炎球菌病即时治疗的策略应包括对急诊部工作人员以及全科医生的教育。
