Fluid therapy for acute bacterial meningitis.

Area of Science:

• Pediatrics
• Infectious Diseases
• Critical Care Medicine

Background:

• Acute bacterial meningitis (ABM) carries high mortality and morbidity, particularly in infants and children.
• Effective management includes prompt antimicrobial therapy and supportive care, with careful fluid and electrolyte balance being critical.
• Both over- and under-hydration can lead to adverse outcomes in ABM patients.

Purpose of the Study:

• To evaluate the impact of different initial fluid administration volumes (up to 72 hours) on mortality and neurological sequelae in acute bacterial meningitis.
• To synthesize evidence from randomized controlled trials (RCTs) on fluid therapy in pediatric bacterial meningitis.

Main Methods:

• Systematic review and meta-analysis of RCTs comparing differing fluid volumes in the initial management of bacterial meningitis.
• Data extracted by multiple authors, with quality assessment using the GRADE approach.
• Meta-analysis performed using fixed-effect models, calculating risk ratios (RR) and mean differences (MD).

Main Results:

• Three RCTs involving 420 children were included; no adult trials were found.
• No significant difference in overall mortality or acute severe neurological sequelae between maintenance and restricted fluid groups (low quality evidence).
• Maintenance fluids showed a statistically significant benefit in reducing spasticity, seizures at 72 hours and 14 days, and chronic severe neurological sequelae at 3 months (low to very low quality evidence).

Conclusions:

• The evidence quality for fluid therapy in pediatric acute bacterial meningitis is low to very low.
• Further RCTs are necessary to definitively guide clinical practice regarding fluid volumes.
• Current evidence is insufficient to recommend maintenance fluids over restricted fluids for treating acute bacterial meningitis.