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Related Experiment Videos

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
PubMed
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.

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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.

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  • 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.