Reasons for delay in administration of antibiotics to patients with meningitis and meningococcaemia.

To determine the extent of, and reasons for, delay in treatment of patients with bacterial meningitis or meningococcal septicaemia, we reviewed the case notes of all adults admitted to Addenbrooke's Hospital, Cambridge with these diagnoses over a 3 year period. Thirty-three patients were identified. Some 70% (21/30) patients admitted via their GPs were not treated before admission. In 12 of these cases, the diagnosis was not considered. Nine patients were not treated despite the diagnosis of meningitis being considered possible or likely; in two cases this was due to suspected penicillin allergy, but no reason was given for the remaining seven. Of 24 patients untreated prior to hospital admission, only nine were given antibiotics before lumbar puncture had been performed. Failure to treat meningitis and meningococcaemia most often resulted from failure to consider the diagnosis, but treatment was delayed in a significant number of cases for no obvious reason. General practitioners and hospital doctors need to have a low threshold for administering antibiotics as soon as the diagnosis of bacterial meningitis or meningococcaemia is considered possible.