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Published on: July 24, 2016
Fluid therapy for acute bacterial meningitis
R M Oates-Whitehead1, I Maconochie, H Baumer
1BMA House, London, UK.
The Cochrane Database of Systematic Reviews
|July 22, 2005
Summary
In acute bacterial meningitis, maintenance fluids may reduce long-term neurological issues like spasticity and seizures, particularly in high-mortality settings. However, evidence is insufficient for early-presenting cases with lower mortality rates.
Area of Science:
- Pediatrics
- Infectious Diseases
- Clinical Medicine
Background:
- Acute bacterial meningitis presents significant mortality and morbidity risks.
- Fluid and electrolyte balance is crucial supportive care, with both over- and under-hydration posing risks.
- Prompt treatment improves survival, especially in pediatric cases.
Purpose of the Study:
- To review randomized controlled trials comparing different fluid volumes in the initial management of bacterial meningitis.
- To assess the impact of fluid management strategies on patient outcomes.
Main Methods:
- Systematic search of multiple databases (Cochrane, MEDLINE, EMBASE, CINAHL) and expert consultation.
- Inclusion of randomized controlled trials (RCTs) evaluating differing fluid volumes.
- Meta-analysis of data from three eligible RCTs using fixed-effect models.
Main Results:
- No significant differences in mortality or overall acute/mild-to-moderate neurological sequelae between maintenance and restricted fluid groups.
- Significant reduction in spasticity, seizures (at 72 hours and 14 days), and chronic severe neurological sequelae with maintenance fluids.
- Largest trial conducted in high-mortality settings, influencing subgroup analysis.
Conclusions:
- Evidence supports using intravenous maintenance fluids over restricted intake in the initial 48 hours for high-mortality settings and late presentations.
- Insufficient evidence exists to guide fluid management in early-presenting pediatric cases with lower mortality rates.
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