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Dexamethasone treatment in childhood bacterial meningitis in Malawi: a randomised controlled trial
E M Molyneux1, A L Walsh, H Forsyth
1Paediatric Department, College of Medicine, Blantyre, Malawi. emolyneux@malawi.net
Insights
Dexamethasone did not improve outcomes for children with bacterial meningitis in Malawi. Steroids did not reduce overall deaths or long-term sequelae in this developing country context.
Area of Science:
- Pediatrics
- Infectious Diseases
- Clinical Trials
Background:
- Childhood pyogenic meningitis requires adjuvant treatment to mitigate inflammatory responses.
- Dexamethasone is commonly used to reduce inflammation in bacterial meningitis.
Purpose of the Study:
- To evaluate the efficacy of dexamethasone as an adjuvant therapy for acute bacterial meningitis in children within a developing country setting.
Main Methods:
- A double-blind, placebo-controlled trial involving 598 children with pyogenic meningitis in Malawi.
- Assessed physical, neurological, developmental, and hearing outcomes at 1 and 6 months post-discharge.
- Primary outcome was overall mortality; secondary outcomes included sequelae and in-hospital deaths.
Main Results:
- No significant difference in overall deaths between the dexamethasone and placebo groups (RR 1.00; p=0.93).
- Rates of sequelae were similar in both groups (28% vs. 28%; RR 0.99; p=0.97).
- In-hospital mortality did not differ between the dexamethasone and placebo arms.
Conclusions:
- Dexamethasone is not an effective adjuvant treatment for acute bacterial meningitis in children in developing countries.
- Findings suggest current steroid protocols may not be beneficial in resource-limited settings.
Background:
Steroids are used as adjuvant treatment in childhood pyogenic meningitis to attenuate host inflammatory responses to bacterial invasion. We aimed to assess the effectiveness of dexamethasone in management of acute bacterial meningitis in a developing country.
Methods:
In a double-blind, placebo controlled trial, we included 598 children with pyogenic meningitis who had been admitted to the children's wards of the Queen Elizabeth Central Hospital, Blantyre, Malawi. We did physical, neurological, developmental, and hearing assessments at 1 and 6 months after discharge. The primary outcome was overall death. Secondary outcomes included sequelae, in-hospital deaths, and death after discharge. Analysis was done by intention to treat.
Findings:
Of the 598 included children, 307 (51%) were assigned to dexamethasone and 295 (49%) to placebo. 338 (40%) of 598 patients had Streptococcus pneumoniae, 170 (28%) Haemophilus influenzae type b, 66 (11%) Neisseria meningitidis, and 29 (5%) Salmonella spp. 78 (13%) patients had no growth on culture. The number of overall deaths was the same in the two treatment groups (relative risk 1.00 [95% CI 0.8-1.25], p=0.93). At final outcome, sequelae were identified in 84 (28%) of children on steroids and in 81 (28%) on placebo (relative risk 0.99 [95% CI 0.78-1.27], p=0.97). The number of children dying in hospital did not differ between groups.
Interpretation:
Steroids are not an effective adjuvant treatment in children with acute bacterial meningitis in developing countries.
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