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Dexamethasone as an adjunctive treatment of bacterial meningitis
N M Shembesh1, S M Elbargathy, I M Kashbur
1Department of Pediatrics, Al-Arab Medical University, Benghazi, Libya.
Insights
Dexamethasone, when added to ceftriaxone, shortened fever duration in pediatric bacterial meningitis. However, it did not significantly impact fatality rates or neurological complications in Libyan children.
Area of Science:
- Pediatrics
- Infectious Diseases
- Neurology
Background:
- Acute bacterial meningitis is a serious infection in infants and children.
- Ceftriaxone is a common antibiotic treatment.
- The role of adjunctive therapies like dexamethasone is under investigation.
Purpose of the Study:
- To evaluate the efficacy of dexamethasone as an adjunct to ceftriaxone in treating acute bacterial meningitis in children.
- To compare the effects on cerebrospinal fluid (CSF) parameters, clinical outcomes, and complications.
Main Methods:
- A randomized controlled trial involving 77 Libyan children aged 1 month to 10 years.
- Group I received ceftriaxone plus intravenous dexamethasone; Group II received ceftriaxone alone.
- Comparison of CSF sugar, protein, and polymorph counts on day 4, alongside clinical response, complications, and sequelae.
Main Results:
- Dexamethasone significantly improved CSF sugar and protein changes (P < 0.05).
- Group I showed a shorter duration of fever (P < 0.05).
- No significant differences were observed in CSF polymorph count, clinical response, complications, fatality, or neurological sequelae.
Conclusions:
- Dexamethasone improved the inflammatory response and reduced fever duration in pediatric bacterial meningitis.
- Adjunctive dexamethasone did not significantly alter fatality rates or the occurrence of neurological sequelae.
- Ceftriaxone remains a primary treatment, with dexamethasone offering potential benefits in managing inflammation and fever.
Abstract:
This study was conducted on 77 Libyan infants and children aged month to 10 years with acute bacterial meningitis. Upon admission, the patients were divided randomly in two groups. Group I (38 patients) received ceftriaxone plus dexamethasone i.v. Group II (39 patients) received ceftriaxone alone. Both groups were compared for mean changes in CSF sugar, CSF protein and CSF polymorph count at 4th day of treatment. There was a significant difference between the two groups in CSF sugar and protein changes (P < 0.05) but not in CSF polymorph (P > 0.05). Both groups showed prompt clinical response and similar occurrence of acute complications, fatality rate and permanent neurological sequelae. However, group I manifested shorter duration of fever (P < 0.05). Dexamethasone improved the inflammatory reaction in acute bacterial meningitis and shortened the duration of fever but it did not have any significant effect on the fatality and the occurrence of neurological sequelae of this disease.