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Arch Dis Child 2001 Volume 85 No 2

Current Evidence For Offering Treatment with Antibiotics Xclusively In Meningococcal Exanthems

We publish few “personal practice” papers. Partly, this is because once they have been through peer review they become more impersonal. In February 1999, however, we considered it would help paediatricians (or, more accurately, some of their acutely ill patients) to learn how the St Mary's Hospital London team handled meningococcal disease (MCD).1 The authors stated: “Meningococcal infection should be suspected in any child who presents with a non-blanching rash as 80% of bacteriologically proved cases will develop purpura or petechiae”. This is a vital aphorism for general practitioners but probably redundant for paediatric SHOs (interns). The dilemma faced by the latter is not when to treat but when it is reasonable not to treat. The key question is what is the false positive rate for diagnosing MCD in the presence of petechiae in very febrile, febrile, or afebrile ill looking or not ill …

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