SynthesisBMJ (Clinical research ed.)2006
Effectiveness of antibiotics given before admission in reducing mortality from meningococcal disease: systematic review.
Synthesis in BMJ (Clinical research ed.), 2006. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
11 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Longer than 2 hours to antibiotics is associated with doubling of mortality in a multinational community-acquired bacterial meningitis cohort.Scientific reports · 2022Pooled it
- Pre-admission antibiotics for suspected cases of meningococcal disease.The Cochrane database of systematic reviews · 2017Pooled it
- Delayed diagnosis is associated with complications following invasive meningococcal disease in Australian adolescents and young adults.Infection · 2026Article
- Prevalence, Characteristics, and Determinants of Suboptimal Care in the Initial Management of Community-Onset Severe Bacterial Infections in Children.JAMA network open · 2022Article
- Care of the patient with invasive meningococcal disease by prehospital emergency medical service clinicians: a scoping review.BMJ open · 2020Article
- Impact of pre-hospital antibiotic therapy on mortality in invasive meningococcal disease: a propensity score study.European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2019Observational
- Invasive meningococcal disease in the 21st century—an update for the clinician.Current neurology and neuroscience reports · 2015Review
- Acute headache.The Ulster medical journal · 2014Review
- Pre-hospital antibiotic treatment and mortality caused by invasive meningococcal disease, adjusting for indication bias.BMC public health · 2009Article
- Improvements in the outcome of children with meningococcal disease.Critical care (London, England) · 2007Article
- Parenteral penicillin before admission to hospital for meningitis.BMJ (Clinical research ed.) · 2006Article
Corrections and comments
- Commented on by
Authors and funding
9 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo review the evidence for effectiveness of treatment with antibiotics before admission in reducing case fatality from meningococcal disease.
designSystematic review. DATA SOURCES: Cochrane register of trials and systematic reviews, database of abstracts of reviews of effectiveness, health technology assessment, and national research register in England and Wales, Medline, Embase, and CAB Health. INCLUDED STUDIES: Studies describing vital outcome of at least 10 cases of meningococcal disease classified by whether or not antibiotics were given before admission to hospital.
results14 observational studies met the review criteria. Oral antibiotic treatment given before admission was associated with reduced mortality among cases (combined risk ratio 0.17, 95% confidence interval 0.07 to 0.44). In seven studies in which all included patients were seen in primary care, the association between parenteral antibiotics before admission and outcome was inconsistent (chi2 for heterogeneity 11.02, P = 0.09). After adjustment for the proportion given parenteral antibiotics before admission, there was no residual heterogeneity. A higher proportion of patients given parenteral antibiotics before admission was associated with reduced mortality after such treatment and vice versa (P = 0.04).
conclusionConfounding by severity is the most likely explanation both for the beneficial effect of oral antibiotics and the harmful effect observed in some studies of parenteral antibiotics. We cannot conclude whether or not antibiotics given before admission have an effect on case fatality. The data are consistent with benefit when a substantial proportion of cases are treated.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.