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Association of Corticosteroid Treatment With Outcomes in Pediatric Patients With Bacterial Meningitis: A Systematic
Chao Tian1, Siyao Jin2, Zinan Zhao3
1School of Pharmaceutical Sciences, Capital Medical University, Beijing, China; Department of Pharmacy, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China.
Insights
Corticosteroids reduce hearing loss in pediatric bacterial meningitis, particularly at low doses. While not improving neurologic sequelae, they decrease fever duration but increase secondary fever risk.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Pharmacology
- Evidence-Based Medicine
Background:
- Corticosteroid use in pediatric bacterial meningitis is debated due to potential risks versus benefits.
- Adjuvant corticosteroid therapy aims to mitigate complications of bacterial meningitis in children.
Purpose of the Study:
- To systematically review and meta-analyze the efficacy and safety of corticosteroids for treating pediatric bacterial meningitis.
- To evaluate the impact of corticosteroids on hearing loss, neurologic sequelae, fever resolution, and mortality.
Main Methods:
- A systematic review and meta-analysis of randomized clinical trials was conducted.
- Searches were performed on major electronic databases up to March 2021.
- Primary outcomes included hearing loss and neurologic sequelae; secondary outcomes assessed fever resolution, mortality, and other complications.
Main Results:
- Corticosteroids significantly reduced hearing loss (RR=0.62) and fever duration (MD=-1.48 days).
- Low-dose corticosteroids (0.6 mg/kg/day) showed a clear benefit in reducing hearing loss.
- An increased risk of secondary fever was observed (RR=1.29), with no significant impact on mortality or neurologic sequelae.
Conclusions:
- Low-dose corticosteroids are beneficial in reducing hearing loss in pediatric bacterial meningitis.
- Corticosteroids shorten fever duration but necessitate monitoring for increased secondary fever risk.
- The findings support the judicious use of low-dose corticosteroids in managing pediatric bacterial meningitis.
Purpose:
Controversy has arisen among the overall benefit and potential risks in the use of corticosteroids for the treatment of pediatric bacterial meningitis. This systematic review and meta-analysis aims to provide evidence of the use of corticosteroids in the treatment of bacterial meningitis in children.
Methods:
Electronic databases (PubMed, Embase, Cochrane Central Register of Controlled Trials, and other databases) were searched from inception until March 9, 2021. Randomized clinical trials focused on corticosteroids as adjuvant therapy in pediatric bacterial meningitis were considered eligible. The primary outcomes were hearing loss and neurologic sequelae. Secondary outcomes were mean days before resolution of fever, mortality, secondary fever, and reactive arthritis. Fixed- or random-effects models were used to evaluate the association between corticosteroids therapy and outcomes by calculating risk ratios (RRs) and mean differences (MDs) with corresponding 95% CIs. Two independent reviewers completed citation screening, data extraction, and risk assessment.
Findings:
Twenty-nine studies with 3433 patients were included. An obvious benefit was found in the treatment of corticosteroids in hearing loss (RR = 0.62; 95% CI, 0.47-0.81; I² = 17%; P = 0.0006). No benefit was found in the rate of neurologic sequelae. However, obvious benefit was found in the low-dosage subgroup (0.6 mg/kg per day) (RR = 0.60; 95% CI, 0.47-0.77; I² = 0%; P < 0.0001) but not in the high-dosage subgroup (0.8 mg/kg per day). An increasing rate of secondary fever was found when using corticosteroids (RR = 1.29; 95% CI, 1.10-1.51; I² = 13%; P = 0.001). Corticosteroids could significantly decrease the mean days before resolution of fever (MD = -1.48; 95% CI, -1.79 to -1.17; I² = 84%, P < 0.00001). No difference was found in the rate of mortality and reactive arthritis.
Implications:
The findings of this study suggest that the administration of corticosteroids is associated with reduced hearing loss and neurologic sequelae especially in children using a low dose of corticosteroids. Benefits also included a reduction in the mean number of days before resolution of fever.
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