The role of fluid restriction in acute bacterial meningitis: A systematic review

Acute bacterial meningitis (ABM) is a neurological emergency that requires prompt and appropriate antibiotics and corticosteroids. Previously fluid restriction was recommended in the treatment of ABM in view of studies reporting hyponatremia which was due to elevated antidiuretic hormone (ADH) levels.

The primary objective was to study the effects of adjuvant fluid restriction in patients of ABM on mortality, neurological and audiological parameters.

Electronic search was performed on the PubMed, Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica Database (EMBASE), Epistemonikos, Web of science, Cochrane Central Register of Controlled Trials (CENTRAL) and Clinical trial registry for studies published from 1946 to 6th Feb 2024. The systematic review included all studies that were Randomized controlled trials (RCT) wherein fluid restriction was employed in patients with ABM. Data were uploaded into the rayyan tool, and the review authors independently screened the articles. Quality of the studies was assessed using the Cochrane 'Risk of bias 2' (ROB2) tool. Risk ratios (RR) with 95% confidence intervals (CI) were used to measure treatment effect and the GRADE framework was used to evaluate the certainty of evidence for each outcome.

Two articles with 407 participants were included in the meta-analyses and both of them had children less than 7 years old. Fluid restriction probably had little or no difference on mortality at admission compared with normal fluid maintenance (RR:1.19; 95% CI 0.77 to 1.85) and also on neurological sequalae (RR 1.31, 95% CI 0.74 to 2.30). A single study reported on mortality and neurological sequelae based on hyponatremia status and there was no difference in between the fluid restricted group and standard maintenance groups.

There are only two studies on the efficacy of Fluid restriction as an adjuv-ant therapy in the treatment of acute bacterial meningitis. Fluid restriction does not appear to significantly alter the mortality or neurological sequelae compared to maintenance therapy.

Prospero id: CRD42024533368.