Dexamethasone adjunctive therapy for bacterial meningitis in children: a retrospective study in Brazil

Macaluso, Anna; Pivetta, Silvia; Maggi, Ruben Schindler; Tamburlini, Giorgio; Cattaneo, Adriano

doi:10.1080/02724936.1996.11747825

Cited by 27 publications

(15 citation statements)

References 16 publications

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“…4,16,20,23 In the United States, before the era of Hib vaccines, more than 70% of bacterial meningitis among children less than five years old was attributable to Hib. 19 Published data from the U.S. show that the incidence of Hib meningitis among children under 5 years of age decreased from 25 cases per 10,5 in 1984, to less than 2.5 cases per 10 5 in 1993 after the introduction of conjugate vaccines since 1988. 21 In Brazil, several studies have been performed over the past ten years evaluating the etiology, treatment, or outcomes of bacterial meningitis in newborns and children.…”

Section: Introductionmentioning

confidence: 99%

Epidemiology of bacterial meningitis among children in Brazil, 1997-1998

2001

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ObjectiveTo document the incidence and the descriptive epidemiology of bacterial meningitis among individuals under age 20 in a geographically defined region in Brazil during the two-year period immediately preceding the introduction of Haemophilus influenzae type b (Hib) vaccines into the national immunization program of Brazil. Methods Population-based epidemiological study of all cases of bacterial meningitis reported among residents of Campinas, Brazil, under age 20 (n=316,570) during the period of 1997-98, using comprehensive surveillance records compiled by the Campinas Health Department from cases reported among hospital inpatients, outpatients, emergency room visits, death certificates, and autopsy reports. ResultsThe incidence of bacterial meningitis (n=274) was 334.9, 115 and 43.5 cases/10 5 person-years (pys) for residents of Campinas under age 1, 5 and 20, respectively. All cases were hospitalized, with an average length of stay of 12 days. Documented prior antibiotic use was 4.0%. The case-fatality rate of bacterial meningitis in individuals under age 20 was 9% (24/274) with 75% of deaths occurring in children under the age of five. The incidence of Hib meningitis (n=26) was 62.8 and 17 cases/ 10 5 pys in children age <1 and <5, respectively. Conclusions

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Section: Introductionmentioning

confidence: 99%

Epidemiology of bacterial meningitis among children in Brazil, 1997-1998

2001

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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%

“…As for observational studies, a Brazilian retrospective analysis of medical records of 179 children between 6 months and 5 years with BM, treated in 1991 and 1992, showed a 14% reduction in mortality and the incidence of neurological and hearing sequelae with the use of dexamethasone as adjuvant therapy (27) . When considering only cases of Hib meningitis, sequelae reduction increased to over 20%.…”

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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“…O diagnóstico clínico foi baseado na história e exame físico do paciente, enquanto o laboratorial, no exame liquórico, considerando aspecto, citologia (celularidade aumentada com predomínio de neutrófilos > 80%), bioquí-mica alterada com hipoglicorraquia (< 30 mg%) e proteínas normais ou elevadas (> 45mg%, em nível lombar), bacterioscopia direta, cultura e contra-imunoeletroforese [1][2][3]5,8 , e na hemocultura colhida antes do início da antibioticoterapia hospitalar.…”

Section: Casuística E Métodosunclassified

Etiological profile of bacterial meningitis in a small hospital

Elias¹,

Junior²,

Câmara³

1998

J Pediatr (Rio J)

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IntroduçãoA meningite bacteriana é uma patologia que acomete crianças em todas as faixas de idade e, além de apresentar um alto índice de letalidade, pode causar seqüelas graves, principalmente, em pacientes no primeiro ano de vida 1 . É uma doença que traz transtornos emocionais tanto para os familiares quanto para a comunidade, gerando angústia para aqueles que convivem direta ou indiretamente com o paciente.Os principais agentes das meningites bacterianas de causa determinada na faixa pediátrica são o Haemophilus influenzae tipo b, Neisseria meningitidis e Streptococcus pneumoniae 2 . Os vírus também representam papel de destaque na etiologia das meningites na infância.Muitas vezes, determinar o agente etiológico torna-se difícil, por existirem muitos fatores que interferem em sua recuperação como antibioticoterapia prévia 5,8 , coleta e armazenamento inadequados dos materiais enviados para exame, diagnóstico precoce da meningite quando ainda é ResumoObjetivo: Analisar o perfil etiológico das meningites bacterianas atendidas em um hospital de pequeno porte na cidade de Ribeirão Preto, SP, comparando-o com a etiologia descrita em outras comunidades.Métodos: Foi realizado estudo retrospectivo de 103 pacientes internados no período de janeiro de 1992 a julho de 1996, com diagnóstico clínico e laboratorial de meningite bacteriana. Como critério clínico levaram-se em consideração a história e exame físico do paciente; como critério laboratorial, o líquor (aspecto, citologia, bioquímica, bacterioscopia direta pela coloração do Gram, cultura e contra-imunoeletroforese) e a hemocultura.Resultados AbstractObjective: To determine the etiologic profile of cases of meningitis treated at a small hospital in Ribeirão Preto, State of São Paulo, and to compare it to those reported for other communities.Methods: a retrospective study was conducted on 103 patients admitted from January 1992 to July 1996 with clinical and laboratory diagnosis of bacterial meningitis. The clinical criteria for diagnosis were based on patient history and physical signs and symptoms, and the laboratory criteria were based on cerebrospinal fluid examination (aspect, cytology, biochemistry, Gram staining, culture and countercurrent immunoelectrophoresis) and blood culture.Results: The etiologic agent was identified in 81,5% of cases: Haemophilus influenzae type b in 32%, Neisseria meningitides in 25,2%, Streptococcus pneumoniae in 8,7%, Staphylococcus aureus and epidermidis in 8,7%, and others agents in 6,9%.Conclusions: The study showed that the cases of bacterial meningitis treated at the Santa Lydia Hospital of Ribeirão Preto are caused by the same agents detected in other places, with Haemophilus influenzae type b being the predominant one. The study also suggests that when many people are involved in the collection of material for laboratory tests, recovery of the agent may become difficult.J. pediatr. (Rio J.). 1998; 74(1): 45-48: meningitis, bacterial meningitis, etiology of meningitis.

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Dexamethasone adjunctive therapy for bacterial meningitis in children: a retrospective study in Brazil

Cited by 27 publications

References 16 publications

Epidemiology of bacterial meningitis among children in Brazil, 1997-1998

Epidemiology of bacterial meningitis among children in Brazil, 1997-1998

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

Etiological profile of bacterial meningitis in a small hospital

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