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Corticosteroids in acute bacterial meningitis.

D van de Beek, J de Gans, P McIntyre

    The Cochrane Database of Systematic Reviews
    |August 15, 2003
    PubMed
    Summary

    Adjuvant corticosteroids significantly reduce mortality and hearing loss in children with bacterial meningitis. While data in adults is limited, recent trials suggest dexamethasone should be initiated with antibiotics for adults with bacterial meningitis.

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    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    • Systematic review of published and unpublished randomized controlled trials (RCTs).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:

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    • 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.