Beneficial effects of dexamethasone in children with pneumococcal meningitis

Kanra, G; Özen, Hasan; Seçmeer, G; Ceyhan, Mehmet; Ecevit, Zafer; Belgi̇n, Erol

doi:10.1097/00006454-199506000-00005

Cited by 102 publications

(33 citation statements)

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“…With respect to meningitis caused by S. pneumoniae, two earlier studies, a retrospective review of 97 pediatric patients (32) and a prospective trial of 106 patients (22), suggested a beneficial effect. More recently, a double-blind placebo-controlled study (31) Because steroids reduce antibiotic penetration into the CSF (30, 55), we conducted experiments in the rabbit meningitis (50). Dexamethasone significantly decreased the penetration and concentrations of vancomycin in CSF and reduced the concentrations of ceftriaxone in CSF as well.…”

Section: Therapy For Meningitis: Clinical Experience and Animal Studiesmentioning

confidence: 99%

Management of meningitis caused by penicillin-resistant Streptococcus pneumoniae

Paris

Ramilo

McCracken

1995

Antimicrob Agents Chemother

124

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Since the isolation of the first penicillin-resistant Streptococcus pneumoniae strain in 1967 (23), there have been many reports of treatment failure in patients with pneumococcal infections caused by strains resistant to penicillin and other antimicrobial agents such as chloramphenicol, macrolides, trimethoprim-sulfamethoxazole, and the cephalosporins. As a result, the selection of antimicrobial agents for the treatment of infections caused by these organisms has become increasingly difficult. In particular, the emergence of pneumococci resistant to broad-spectrum cephalosporins has limited the choices of antibiotics for the treatment of pneumococcal meningitis. This minireview focuses on the specific problems encountered in managing patients with penicillin-and cephalosporin-resistant pneumococcal meningitis and discusses some therapeutic alternatives that have recently been explored.

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Section: Therapy For Meningitis: Clinical Experience and Animal Studiesmentioning

confidence: 99%

Management of meningitis caused by penicillin-resistant Streptococcus pneumoniae

Paris

Ramilo

McCracken

1995

Antimicrob Agents Chemother

124

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“…Thus, there is insufficient evidence in the literature to indicate routine use of dexamethasone as adjuvant therapy in BM. Its use seems to only have been justified in some older clinical trials and observational studies (14,15,27,28) .…”

Section: Discussionmentioning

confidence: 99%

Revisão sistemática do uso da dexametasona como terapia adjuvante na meningite bacteriana em crianças

Prats

Gaspar

Ribeiro

et al. 2012

Rev. paul. pediatr.

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Revisão sistemática do uso da dexametasona como terapia adjuvante na meningite bacteriana em criançasRevisión sistemática del uso de la dexametasona como terapia adyuvante en la meningitis bacteriana en niños João Antonio G. G ABSTRACTObjective: To analyze the best available evidence from the last 15 years on the benefits of adjuvant therapy with dexamethasone for bacterial meningitis in children.Data sources: Randomized controlled trials comparing dexamethasone to placebo and/or other adjuvant therapies in patients with bacterial meningitis diagnosed by biochemical, cytological and/or microbiological data. Studies with patients from 29 days to 18 years of age, from 1996 to 2011, were searched at Medline, Lilacs and SciELO databases. The evaluated outcomes were mortality and development of neurological and/or hearing impairment. Studies related to tuberculous meningitis were excluded.Data synthesis: With the specified criteria, five published studies were identified corresponding to four study protocols. None of the studies showed differences between dexamethasone and placebo for the evaluated outcomes. All analyzed studies had high methodological quality (Jadad et al score=5).Conclusions: Current evidence is insufficient to support routine adjuvant therapy with dexamethasone to reduce mortality, hearing impairment, or neurological sequelae in pediatric patients with non-tuberculous bacterial meningitis.Key-words: meningitis, bacterial; dexamethasone; deafness; mortality. RESUMOObjetivo: Analisar a melhor evidência disponível nos últimos 15 anos com relação aos benefícios da terapia adjuvante com dexametasona na meningite bacteriana em população pediátrica.Fontes de dados: Das bases de dados Medline, Lilacs e SciELO, foram analisados ensaios clínicos randomizados de 1996 a 2011, os quais comparavam a dexametasona ao placebo e/ou a outra terapia adjuvante em pacientes com meningite bacteriana diagnosticada laboratorialmente por critérios quimiocitológicos e/ou bacteriológicos, na faixa etária de 29 dias aos 18 anos. Os desfechos avaliados foram mortalidade e ocorrência de sequelas neurológicas e/ou auditivas. Foram excluídos estudos relacionados à meningite tuberculosa.Síntese dos dados: Com os critérios utilizados, foram identificadas cinco publicações correspondentes a quatro protocolos de estudo. Nenhum dos estudos mostrou diferenças entre a dexametasona e o placebo para os desfechos avaliados. Os estudos analisados tiveram alta qualidade (escore de Jadad et al=5).Conclusões: As evidências encontradas na literatura são insuficientes para indicar de forma rotineira o uso da dexametasona como terapia adjuvante para redução de mortalidade, perda auditiva e sequelas neurológicas em pacientes pediátricos com meningite bacteriana não tuberculosa.Palavras-chave: meningite bacteriana; dexametasona; surdez; mortalidade. João Antonio G. G. Prats et al RESUMEN Objetivo:El presente estudio tiene por objetivo el análisis de la mejor evidencia disponible los últimos 15 años respecto a los beneficios de la terapia adyuvant...

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“…While individual studies demonstrated statistical benefit (7,9), others showed either marginal benefit (10,28) or no demonstrable benefit (29,30). These and other randomized clinical trials performed since 1988 were analyzed in a meta-analysis published in 1997 (8).…”

Section: Discussionmentioning

confidence: 99%

“…Published studies showed either decreased hearing loss (7,8) or decreased neurological deficits (9) in patients with H influenzae type b meningitis treated with dexamethasone. The benefit of dexamethasone in S pneumoniae meningitis is controversial because a small, double-blind study showed a trend for lower hearing loss in dexamethasone-treated patients than in placebo-treated patients, but the results were not statistically significant (10). There are no adequate published data on the effect of dexamethasone on the outcome of N meningitidis or partially treated (PT) meningitis.…”

mentioning

confidence: 99%

Dexamethasone and antibiotics for the empirical treatment of bacterial meningitis in Canadian children: A survey of paediatric infectious diseases specialists

Tan

Davies

2002

Paediatrics &Amp; Child Health

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PURPOSE:With the changing epidemiology of the etiological agents causing bacterial meningitis in Canada, the purposes of this study were to determine what empirical antibiotic(s) is/are advocated, and whether dexamethasone is recommended as adjunctive therapy by paediatric infectious diseases specialists for suspected meningitis caused by Streptococcus pneumoniae, Neisseria meningitides, Haemophilus influenzae type b, and partially treated (PT) bacterial meningitis. METHODS: A questionnaire invoking the specialists' preferred choices in treating bacterial meningitis was circulated by e-mail in March 1999 to 41 paediatric infectious diseases specialists or microbiologists (Paediatric Investigators Collaborative Network on Infections in Canada [PICNIC] members) who practised in 13 paediatric centres located in eight provinces. RESULTS: Thirty-two (78% response rate) replies were received by July 1999 from 11 paediatric centres in seven provinces. Dexamethasone was recommended by 11 of 32 (34%) respondents for suspected S pneumoniae, four of 32 (12%) for suspected N meningitides, 18 of 32 (56%) for suspected H influenzae type b and five of 32 (16%) for suspected PT meningitis. A trend for more frequent recommended use of dexamethasone for S pneumoniae, H influenzae type b and N meningitides meningitis was found in eastern provinces (Ontario, Quebec and Nova Scotia), as opposed to the western provinces (Manitoba, Saskatchewan, Alberta and British Columbia). The most commonly recommended first line empirical antibiotic therapy was vancomycin plus 3rd-generation cephalosporin (V+3C). This was recommended by 27 of 32 (84%) respondents for suspected S pneumoniae, seven of 32 (22%) for suspected N meningitides, six of 32 (19%) for suspected H influenzae type b and 24 of 32 (75%) for PT meningitis; the remainder recommended using a 3C empirically for each type of meningitis. The major reason cited by respondents for using V+3C for suspected S pneumoniae was the presence of high-and intermediate-level penicillin-resistant S pneumoniae in their centres. No differences were found in the choice of antibiotic(s) between practitioners in the eastern and western provinces. CONCLUSIONS: Although regional differences exist, the majority of paediatric infectious diseases experts no longer favour the use of dexamethasone for empirical therapy in most cases of bacterial meningitis. V+3C has become the regimen of choice in Canada for most cases of suspected bacterial meningitis.

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Beneficial effects of dexamethasone in children with pneumococcal meningitis

Cited by 102 publications

References 0 publications

Management of meningitis caused by penicillin-resistant Streptococcus pneumoniae

Management of meningitis caused by penicillin-resistant Streptococcus pneumoniae

Revisão sistemática do uso da dexametasona como terapia adjuvante na meningite bacteriana em crianças

Dexamethasone and antibiotics for the empirical treatment of bacterial meningitis in Canadian children: A survey of paediatric infectious diseases specialists

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