Related Experiment Video

Updated: Aug 10, 2026

Inducing Meningococcal Meningitis Serogroup C in Mice via Intracisternal Delivery
10:03

Inducing Meningococcal Meningitis Serogroup C in Mice via Intracisternal Delivery

Published on: November 5, 2019

Steroids in adults with acute bacterial meningitis: a systematic review

Diederik van de Beek1, Jan de Gans, Peter McIntyre

  • 1Department of Neurology, Academic Medical Centre, University of Amsterdam, Netherlands. D.vandeBeek@amc.uva.nl

The Lancet. Infectious Diseases
|March 5, 2004
PubMed

Insights

Adjunctive steroid therapy significantly reduces mortality and neurological sequelae in adults with bacterial meningitis. This treatment is justified for suspected acute community-acquired bacterial meningitis, showing no detectable adverse effects.

Area of Science:

  • Infectious Diseases
  • Neurology
  • Pharmacology

Background:

  • Bacterial meningitis, though uncommon, leads to high mortality and morbidity even with optimal antibiotic treatment.
  • Previous trials suggest adjunctive steroids benefit adults with pneumococcal meningitis, but data on other pathogens and adverse events are limited.

Purpose of the Study:

  • To conduct a quantitative systematic review on the efficacy and safety of adjunctive steroid therapy in adults with acute bacterial meningitis.

Main Methods:

  • Systematic review and meta-analysis of five randomized controlled trials involving 623 adult patients.
  • Included patients had bacterial meningitis caused by various organisms, including Streptococcus pneumoniae and Neisseria meningitidis.

Main Results:

  • Adjunctive steroids significantly reduced overall mortality (RR 0.6, 95% CI 0.4-0.8) and neurological sequelae (RR 0.6, 95% CI 0.4-1).
  • A significant reduction in case-fatality was observed in pneumococcal meningitis (RR 0.5, 95% CI 0.3-0.8).
  • Adverse events were similar between steroid and placebo groups, with no significant increase in gastrointestinal bleeding.

Conclusions:

  • Adjunctive steroid therapy is associated with reduced mortality and neurological sequelae in adults with acute bacterial meningitis.
  • Routine steroid administration with the first antibiotic dose is justified for suspected community-acquired bacterial meningitis in adults due to demonstrated benefits and lack of significant adverse effects.

More Related Videos

Knee Arthrocentesis in Adults04:41

Knee Arthrocentesis in Adults

Published on: February 25, 2022

The Adjuvant Efficacy of Angong Niuhuang Pill in the Treatment of Viral Encephalitis: A Meta-Analysis of Randomized Controlled Trials08:36

The Adjuvant Efficacy of Angong Niuhuang Pill in the Treatment of Viral Encephalitis: A Meta-Analysis of Randomized Controlled Trials

Published on: April 19, 2024

Related Concept Videos

Bacterial Meningitis01:24

Bacterial Meningitis

Bacterial meningitis is a severe infectious disease involving inflammation of the meninges, the protective membranes surrounding the brain and spinal cord. It occurs when pathogenic bacteria cross the blood–brain barrier and enter the cerebrospinal fluid. Common causative organisms include Neisseria meningitidis, Streptococcus pneumoniae, Haemophilus influenzae type b, Listeria monocytogenes, and Escherichia coli K1. The exact route of entry varies by pathogen and host condition.Routes of Entry...
Viral Meningitis01:18

Viral Meningitis

Viral meningitis is the most common form of meningitis and is often referred to as aseptic meningitis to indicate the absence of bacterial involvement. It is generally milder than bacterial meningitis, with symptoms including fever, headache, stiff neck, drowsiness, nausea, photophobia, and vomiting. Rarely, more severe manifestations or death may occur. Common causative agents include enteroviruses, particularly coxsackie A and B viruses and echoviruses, all members of the Enterovirus genus...
Cryptococcal Meningitis01:27

Cryptococcal Meningitis

Cryptococcal meningitis is a life-threatening opportunistic infection predominantly associated with HIV/AIDS, accounting for over 100,000 deaths annually worldwide. However, it also affects individuals with other forms of immunosuppression, including those undergoing immunosuppressive therapy, organ transplant recipients, patients with innate immunodeficiencies, and individuals with hematological disorders. The infection is caused mainly by Cryptococcus neoformans and Cryptococcus gattii,...
Bacterial Meningitis I: Introduction01:22

Bacterial Meningitis I: Introduction

Bacterial meningitis is a severe, life-threatening inflammation of the meninges, particularly the pia mater and arachnoid mater, affecting the subarachnoid space, ventricles, and cerebrospinal fluid (CSF). If untreated, it can lead to significant neurological complications or death.Causative AgentsCommon pathogens vary with age and immune status. In adults, major organisms include Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae. Streptococcus agalactiae (group B...
Bacterial Meningitis II: Pathophysiology01:26

Bacterial Meningitis II: Pathophysiology

Bacterial meningitis typically begins when pathogens such as Neisseria meningitidis and Streptococcus pneumoniae colonize the nasopharynx and invade the bloodstream. This process is facilitated by bacterial virulence factors, such as polysaccharide capsules, which resist phagocytosis and complement-mediated killing. Less commonly, bacteria reach the central nervous system via contiguous spread from infections like otitis media or sinusitis, through congenital or acquired dural defects, or...
Brain Abscess l: Introduction01:26

Brain Abscess l: Introduction

A brain abscess is a focal, intracerebral infection characterized by a localized collection of pus within the brain parenchyma, resulting from microbial invasion and the body’s inflammatory response. It progresses through stages: early and late cerebritis, followed by early and late capsule formation, reflecting tissue destruction, immune response, and eventual encapsulation.Etiology and PathogenesisCausative organisms vary with source and host factors, often involving polymicrobial infections,...