Dr Radetsky has raised the important point of the ability of preadmission antibiotic therapy to significantly decrease the risk of a fatal outcome. As he observed, we did not stratify the relationship between preadmission antibiotic therapy and outcome by clinical form of meningococcal disease in the primary series of patients (derivation set). Such a stratification is shown in the Table, and demonstrates that when the ability of preadmission antibiotics to improve survival was examined by clinical form of the disease, preadmission anti biotic therapy could improve survival in each of them. However, the differences were statistically significant only in the acute form and when all forms were analyzed together. The subacute form showed a trend to significance, whereas in the fulminant form, the low number of patients provided inadequate power to test the hypothesis.
The assumption that preadmission antibiotic therapy was more frequent in subacute and acute forms of the disease is correct
Barquet N, Domingo P, Caylà JA. Prognostic Factors in Meningococcal Disease-Reply. JAMA. 1997;278(20):1658-1659. doi:10.1001/jama.1997.03550200034021