Dexamethasone Therapy for Bacterial Meningitis: Better Never Than Late?

Abstract

A multicentre randomized controlled trial was conducted in children with bacterial meningitis using dexamethasone or placebo for four days within 24 h of starting antibiotics. Primary outcomes were hearing loss and neurological abnormalities at 12 months after meningitis. The dexamethasone (n=50) and placebo (n=51) groups were similar in age, severity of illness and etiological agent. Hearing loss occurred in 10% and 11% of the dexamethasone and placebo groups and neurological deficits occurred in 20% and 18% of patients, respectively. Duodenal perforation occurred in one dexamethasone-treated child. In conclusion, there was no significant benefit in those receiving dexamethasone. The lack of benefit may have been due to the delay in administration of dexamethasone (median delay of 11 h after antibiotics). Therefore, if dexamethasone is used for meningitis it should be given immediately with the antibiotic.

The risk of sequelae due to pneumococcal meningitis in high-income countries: A systematic review and meta-analysis

“…Hence this paper should provide useful results for economic evaluation of present and future vaccines against pneumococcal infection. n/a n/a n/a n/a Auburtin 29 40.0% 25.0% 5.0% n/a n/a 10.0% n/a n/a Auburtin 32 34.3% 13.3% n/a n/a n/a 8.6% n/a n/a Bedford 3 49.7% n/a n/a n/a n/a n/a n/a n/a Benca 33 23.3% n/a n/a n/a n/a n/a n/a n/a Buckingham 34 n/a n/a n/a n/a n/a 6.7% n/a n/a Casado-Flores 35 36.3% 45.2% n/a 11.8% n/a 21.5% n/a n/a Davis 36 33.7% 21.2% n/a n/a 3.8% 17.3% n/a n/a De Lalla 37 4.5% n/a n/a n/a n/a n/a n/a n/a Eriksson 38 n/a 6.5% n/a n/a n/a n/a n/a n/a Faella 39 21.4% 7.1% n/a n/a n/a n/a n/a n/a Fiore 40 13.8% n/a n/a n/a n/a n/a n/a n/a Fortnum 41 n/a 4.5% n/a n/a n/a n/a n/a n/a Grimwood 42 47.1% n/a n/a n/a n/a n/a n/a n/a Hanna 43 n/a 3.0% n/a n/a n/a 3.0% n/a n/a Hoogman 44 n/a n/a n/a n/a n/a n/a n/a 27.8% Husain 45 n/a 18.9% n/a n/a 11.3% 7.5% n/a 7.5% Ishidawa 30 35.7% n/a n/a n/a n/a n/a n/a n/a Ispahani 4 26.2% 13.7% n/a n/a n/a 9.8% n/a n/a Kaaresen 46 42.9% 28.6% n/a n/a n/a n/a n/a n/a Kallio 47 37.5% 37.5% n/a n/a n/a n/a n/a n/a Kastenbauer 48 n/a 25.8% n/a n/a n/a n/a n/a n/a Kellner 17 41.4% 17.2% n/a n/a n/a n/a n/a n/a Kennedy (control) 49 32.6% n/a n/a n/a n/a n/a n/a n/a Kennedy (intervention) 49 11.4% n/a n/a n/a n/a n/a n/a n/a Kilpi 27 50.0% 50.0% n/a n/a n/a n/a n/a n/a King (control) 50 16.7% 16.7% n/a n/a n/a n/a n/a n/a King (intervention) 50 42.9% 28.6% n/a n/a n/a n/a n/a n/a King 51 28.2% n/a n/a n/a n/a 11.2% n/a 6.7% Kirkpatrick 52 20.0% 13.4% n/a n/a n/a 1.5% n/a n/a Kornelisse 53 36.2% 18.8% 2.9% n/a 10.1% 10.1% n/a 7.2% Korshin 54 42.9% n/a n/a n/a n/a n/a n/a n/a Kragsbjerg 55 29.2% 4.2% n/a n/a 4.2% n/a n/a n/a Lazzarini 56 25.0% n/a n/a n/a n/a n/a n/a n/a ...…”

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

“…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).…”

Role of Dexamethasone in Meningitis

“…(King, 1994). Regarding H. Influenzae meningitis in children older than six week age, the use of steroid prior to antibiotics is recommended by American Academy of Pediatrics and as describe Infectious Diseases Society of America (IDSA) guidelines 2004.…”

“…Still dexamethasone has a role in reducing the inflammatory exudates if given with or given soon after the initial antibiotics preferably within one hour, but this time interval is not clearly defined in literature. (King SM et al, 1994).…”