Review of the evidence for prehospital administration of benzyl penicillin in meningoccocal septicaemia - experience in Queensland

Meningococcal disease is a rare but potential killer in both adults and children. Community acquired meningococcal disease is caused by a variety of serogroups of Neisseria meningitides. Of the five main subgroups, A, B, C, W135 and Y, serogroups, A and Y are rarely identified in Australia. Alternatively, Serogroup B accounts for the highest number of cases followed by serogroup C strains. Meningococcal infection causes two distinct clinical profiles, though dual presentations are not uncommon. The first, meningitis presenting alone, is the more common form of infection and requires urgent but not immediate medical treatment. Conversely the second presentation, meningococcal septicaemia, is considered a medical emergency. In Queensland, careful and detailed consideration of the evidence for introduction of benzyl penicillin for the prehospital treatment of meningococcal septicaemia has been conducted. Notwithstanding the seriousness of the septicaemic presentation, these reviews have resulted in the decision not to introduce this drug in the ambulance service at the time. This paper describes the reasoning behind these decisions.