Meningitis clusters linked to antibiotics

Sunday Times 13/10/1996

DEATHS from meningitis have been linked for the first time to the high use of antibiotic drugs in a study of towns stricken by unexplained clusters of the disease, write Lois Rogers and Cherry Norton.

The research found a significantly higher incidence of meningitis in areas where doctors prescribed more antibiotics than in other towns.

The finding has caused alarm among bereaved families and raised anxiety about the growing problem of "superbugs" which have developed resistance to antibiotics because of overuse of the drugs.

Scientists are now calling for more research into potentially harmful side effects of antibiotics to see whether doctors should be given more detailed advice on restricting prescriptions of the drugs.

Meningitis, a potentially fatal inflammation of the brain caused by a virus or, more seriously, by a variety of bacteria, infects about 2,500 people annually in Britain and causes about 200 deaths, mostly among children and teenagers.

Last year it claimed the highest number of victims for 20 years, causing a total of 1% deaths in England and Wales alone. Another seasonal surge is predicted with the onset of cold weather this winter. The research. conducted by a team of specialists based in Gloucester compared populations in four towns which had a very high incidence of B-group bacterial meningitis with another four towns which had a very low incidence.

In the towns with meningitis clusters, there were almost 50% more prescriptions for antibiotics and nine times more case of the killer disease than in the low-incidence" towns.

One antibiotic drug, erythromycin, which is marketed under a variety of brand name and is used as a routine treatment for sore throats appeard with mysterious frequency or the prescriptions. It was being used up to four times more often in the towns with the serious meningitis problem than in the other towns.

Although the research team has been unable to establish that antibiotics are responsible for the increased incidence of meningitis, it says its findings provide compelling reasons for more detailed investigation.

One of the researchers, James Stuart, a senior doctor with a specialist interest in epidemics. said: ‘Although this finding is a bit odd, we are not saying that people should stop prescribing erythromycin because it causes meningitis. We haven’t been able to come up with anything concrete."

His colleague, Keith Cartwright, a microbiologist who has devoted much of his career to the study of meningitis, was equally baffled. "The erythromycin link was completely unexpected," he said.

Their investigation followed a prolonged outbreak of the disease in Gloucester and Stroud, Nailsworth and Stonehouse in the western Cotswolds. It spanned a five-year period during which 88 people contracted the disease, of whom six died.

The inquiry follows studies in America and France suggesting antibiotics might kill natural bacteria in the respiratory tract which inhibit the ability of meningitis to cause infection.

Bereaved families in the Gloucester area endorsed the scientists’ calls for further research. Christine Meek, 40, a nurse from Gloucester whose eight-year-old son, David, died within 10 hours of developing the disease, said he went from one course of antibiotics to the next for a series of throat infections throughout his short life.

"I have often wondered about it. David had lots of different antibiotics, amoxycillin and penicillin, as well as erythromycin. I watched him die in front of me. I do wonder whether he might have survived if he had not had so many drugs."

Her second child, Melissa. aged 18 months, is now participating in early trials of a vaccine which could protect against the B strain of the disease, although such a treatment is some years off.

Andrew Pollard, a paediatric disease research fellow working on meningococcal diseases at St Mary’s hospital. London, said: "This research is important because it suggests an association with antibiotic prescribing in increasing incidence of the disease, but it doesn’t prove anything.

"I don’t think GPs should change their prescribing habits at the moment."