Open Access Open Badges Research article

Pre-hospital antibiotic treatment and mortality caused by invasive meningococcal disease, adjusting for indication bias

Emilio Perea-Milla16, Julián Olalla1*, Emilio Sánchez-Cantalejo26, Francisco Martos3, Petra Matute-Cruz4, Guadalupe Carmona-López26, Yolanda Fornieles2, Aurelio Cayuela5, Javier García-Alegría16 and the ANCA Group

Author Affiliations

1 Hospital Costa del Sol, Marbella, Spain

2 Escuela Andaluza de Salud Pública, Granada, Spain

3 Facultad de Medicina, Universidad de Málaga, Málaga, Spain

4 Dirección General de Salud Pública, Tenerife, Spain

5 Hospital Virgen del Rocío, Seville, Spain

6 CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain

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BMC Public Health 2009, 9:95  doi:10.1186/1471-2458-9-95

Published: 3 April 2009



Mortality from invasive meningococcal disease (IMD) has remained stable over the last thirty years and it is unclear whether pre-hospital antibiotherapy actually produces a decrease in this mortality. Our aim was to examine whether pre-hospital oral antibiotherapy reduces mortality from IMD, adjusting for indication bias.


A retrospective analysis was made of clinical reports of all patients (n = 848) diagnosed with IMD from 1995 to 2000 in Andalusia and the Canary Islands, Spain, and of the relationship between the use of pre-hospital oral antibiotherapy and mortality. Indication bias was controlled for by the propensity score technique, and a multivariate analysis was performed to determine the probability of each patient receiving antibiotics, according to the symptoms identified before admission. Data on in-hospital death, use of antibiotics and demographic variables were collected. A logistic regression analysis was then carried out, using death as the dependent variable, and pre-hospital antibiotic use, age, time from onset of symptoms to parenteral antibiotics and the propensity score as independent variables.


Data were recorded on 848 patients, 49 (5.72%) of whom died. Of the total number of patients, 226 had received oral antibiotics before admission, mainly betalactams during the previous 48 hours. After adjusting the association between the use of antibiotics and death for age, time between onset of symptoms and in-hospital antibiotic treatment, pre-hospital oral antibiotherapy remained a significant protective factor (Odds Ratio for death 0.37, 95% confidence interval 0.15–0.93).


Pre-hospital oral antibiotherapy appears to reduce IMD mortality.