Variations in chemoprophylaxis for meningococcal disease: a retrospective case note review, analysis of routine prescribing data and questionnaire of general practitioners.

Peter J Marks,Keith R Neal

doi:10.1186/1471-2458-1-16

Abstract

BackgroundInvasive meningococcal disease is a significant cause of mortality and morbidity in the UK. Administration of chemoprophylaxis to close contacts reduces the risk of a secondary case. However, unnecessary chemoprophylaxis may be associated with adverse reactions, increased antibiotic resistance and removal of organisms, such as Neisseria lactamica, which help to protect against meningococcal disease. Limited evidence exists to suggest that overuse of chemoprophylaxis may occur. This study aimed to evaluate prescribing of chemoprophylaxis for contacts of meningococcal disease by general practitioners and hospital staff.MethodsRetrospective case note review of cases of meningococcal disease was conducted in one health district from 1st September 1997 to 31st August 1999. Routine hospital and general practitioner prescribing data was searched for chemoprophylactic prescriptions of rifampicin and ciprofloxacin. A questionnaire of general practitioners was undertaken to obtain more detailed information.ResultsPrescribing by hospital doctors was in line with recommendations by the Consultant for Communicable Disease Control. General practitioners prescribed 118% more chemoprophylaxis than was recommended. Size of practice and training status did not affect the level of additional prescribing, but there were significant differences by geographical area. The highest levels of prescribing occurred in areas with high disease rates and associated publicity. However, some true close contacts did not appear to receive prophylaxis.ConclusionsReceipt of chemoprophylaxis is affected by a series of patient, doctor and community interactions. High publicity appears to increase demand for prophylaxis. Some true contacts do not receive appropriate chemoprophylaxis and are left at an unnecessarily increased risk.

Highlights

Invasive meningococcal disease is a significant cause of mortality and morbidity in the UK
Data on contacts identified at the time were obtained from the Consultant for Communicable Disease Control's (CCDC) records and were assessed against the current UK guidelines [12]
Receipt of chemoprophylaxis is affected by a series of patient, doctor and community interactions

Summary

Introduction

Invasive meningococcal disease is a significant cause of mortality and morbidity in the UK. BMC Public Health 2001, 1 http://www.biomedcentral.com/1471-2458/1/16 creased risk of a secondary case of meningococcal disease amongst household contacts, which is between 450 and 1650 times that of the general population [3,4,5,6]. This is in part explained by the fact that household and kissing contacts frequently carry the same pathogenic strain[7]. The same assumption was made for single 250 mg doses of ceftriaxone

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