Corticosteroids in acute bacterial meningitis

Area of Science:

• Neurology
• Infectious Diseases
• Pharmacology

Background:

• Acute bacterial meningitis has a high mortality rate (10-30%) and significant risk of hearing loss (5-40%).
• The role of corticosteroids as adjuvant therapy in bacterial meningitis is controversial, particularly in adults.

Purpose of the Study:

• To systematically review the efficacy and safety of adjuvant corticosteroid therapy in children and adults with acute bacterial meningitis.

Main Methods:

• Systematic review of published and unpublished randomized controlled trials (RCTs).
• Searched multiple databases (Cochrane, MEDLINE, EMBASE, HEALTHLINE) up to April 2002.
• Two reviewers independently assessed trial quality and extracted data.

Main Results:

• Eighteen RCTs involving 1853 patients were included.
• Adjuvant corticosteroids reduced overall case fatality (RR 0.76) and severe hearing loss (RR 0.36).
• In children, corticosteroids reduced hearing loss for H. influenzae and other bacterial meningitis; adults showed reduced case-fatality (RR 0.38) with limited data.

Conclusions:

• Adjuvant corticosteroids are beneficial for children with acute bacterial meningitis, reducing mortality and hearing loss.
• Limited adult data showed a trend favoring corticosteroids; however, a recent trial (De Gans 2002) demonstrated dexamethasone reduced adult mortality.
• Dexamethasone should be administered to all adults with bacterial meningitis, initiated before or with the first antibiotic dose.