[Value of corticosteroids in bacterial meningitis]

Bacterial meningitis mortality largely results from the intense host inflammation response to infection. Lysis of bacteria releases bacterial components that stimulate production of cytokines. Cerebrospinal fluid concentrations of these cytokines have been shown to correlate with the severity of the meningitis in both experimental and clinical situations. Dexamethasone has an antiinflammatory effect superior to methylprednisolone. It is the only agent with which significant clinical studies have yet been performed. A recent study recommends the routine use of dexamethasone with Haemophilus influenzae meningitis. The immediate and long-term clinical profiles indicate significantly better outcomes for the dexamethasone group. It is prudent to administer dexamethasone before the first parenteral dose of antibiotic to prevent the release of bacterial components induced by bacterial lysis. The search for agents that down modulate inflammation more strongly continues. Some monoclonal antibodies are superior to dexamethasone in experimental meningitis without modification of antibiotic pharmacokinetics.