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Vincent J. Wang, MD; Richard Malley, MD; Gary R. Fleisher, MD; Stanley H. Inkelis, MD; Nathan Kuppermann, MD, MPH

Arch Pediatr Adolesc Med. 2000;154:556-560.

Background  Data from an earlier study suggest that patients with unsuspected meningococcal disease (UMD) cannot be differentiated easily from febrile children with viral syndromes on the basis of physical examinations or peripheral blood counts. Some children with meningococcal disease therefore are treated inadvertently as outpatients.

Objective  To determine whether antibiotic therapy administered at the outpatient visit prevents complications, permanent sequelae, or death in children with UMD.

Methods  We reviewed the medical records of patients younger than 20 years with invasive meningococcal disease at 7 pediatric referral centers from January 1, 1981, through December 31, 1996. Patients were considered to have UMD if they underwent evaluation and discharge as outpatients and if blood and/or cerebrospinal fluid cultures obtained at evaluation yielded Neisseria meningitidis. We compared the frequency of development of complications (meningitis, sepsis, and pericarditis), permanent sequelae (limb amputation, skin grafting, and persistent neurologic disability) or death between patients who did and did not receive antibiotics at the outpatient visits.

Results  Of 58 children with UMD, 19 (33%) received antibiotics and 39 (67%) did not. Complications occurred significantly less frequently in the antibiotic-treated group (7/19 [37%] vs 27/39 [69%]; odds ratio [OR], 0.26; 95% confidence interval [CI], 0.08-0.81; P=.03). There was no significant difference in death or permanent sequelae between groups (0/19 vs 3/39 [8%]; OR, 0; 95% CI, 0-2.61; P=.54). There was insufficient power, however, to exclude the possibility of a clinically meaningful difference between the groups with regard to these latter outcomes.

Conclusions  Antibiotic administration to young patients with UMD at the time of the outpatient visit is associated with a reduction in complications from this disease. Although the routine use of antibiotics in febrile outpatients younger than 20 years cannot be advocated, empirical treatment should be considered in the setting of higher probability of meningococcal disease.

From the Divisions of Emergency Medicine (Drs Wang, Malley, and Fleisher) and Infectious Diseases (Dr Malley), Department of Medicine, Children's Hospital, Boston, Mass; the Departments of Emergency Medicine and Pediatrics, Harbor–University of Califoria–Los Angeles Medical Center, Torrance (Dr Inkelis); and the Division of Emergency Medicine, Departments of Internal Medicine and Pediatrics, University of California–Davis School of Medicine (Dr Kuppermann).

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