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Beneficial effects of dexamethasone in children with pneumococcal meningitis
1Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey.
Insights
Dexamethasone therapy in children with pneumococcal meningitis showed a trend toward reduced hearing loss and neurological sequelae compared to placebo, with a significant reduction in hearing impairment at 3 months.
Area of Science:
- Pediatrics
- Infectious Diseases
- Neurology
Background:
- Bacterial meningitis, particularly Streptococcus pneumoniae meningitis, poses significant risks for neurological sequelae in children.
- Dexamethasone has been investigated for its potential to mitigate inflammation and reduce complications associated with bacterial meningitis.
Purpose of the Study:
- To evaluate the efficacy of dexamethasone as an adjunctive therapy to antimicrobial treatment in children with Streptococcus pneumoniae meningitis.
- To assess the impact of dexamethasone on hearing loss and overall neurological outcomes.
Main Methods:
- A prospective, double-blind, placebo-controlled trial involving 56 children over 2 years old with Streptococcus pneumoniae meningitis.
- Patients received either dexamethasone (0.6 mg/kg/day for 4 days) or placebo alongside standard antimicrobial therapy.
- Outcomes including fever duration, secondary infections, seizures, rash, hearing loss (via audiometry), and neurological sequelae were assessed.
Main Results:
- While not statistically significant at 6 weeks, the placebo group showed higher rates of sensorineural hearing loss (23%) and neurological sequelae (26.9%) compared to the dexamethasone group (7.4% for both).
- At 3 months, dexamethasone therapy resulted in a significantly lower incidence of hearing impairment (3.7%) compared to the placebo group (23%).
- No significant differences were observed in fever duration, secondary fever, electrolyte imbalance, seizures, or rash between the groups.
Conclusions:
- Adjunctive dexamethasone therapy in children with pneumococcal meningitis may reduce the incidence of hearing impairment and neurological sequelae.
- The observed benefits, particularly regarding hearing loss, became statistically significant at the 3-month follow-up.
- Further research may be warranted to confirm these findings and optimize dexamethasone treatment protocols for pediatric meningitis.
Abstract:
Fifty-six children older than 2 years with meningitis caused by Streptococcus pneumoniae were enrolled in a prospective, double blind, placebo-controlled trial to evaluate the efficacy of dexamethasone therapy in addition to antimicrobial therapy. Twenty-nine of 56 received dexamethasone (0.6 mg/kg/day iv, divided into 4 daily doses for 4 days) and the remaining 27 received placebo. At the beginning of therapy the clinical and laboratory characteristics of the patients in the treatment groups were comparable, except for the Glasgow coma score (P = 0.004), which was lower in the dexamethasone group. Patients were examined daily during hospitalization and 6 weeks after discharge from the hospital. Hearing was assessed 6 weeks after discharge by means of pure tone audiometry. Two patients in the dexamethasone group and one patient in the placebo group died. There were no differences between the two groups with regard to the duration of fever, the incidence of secondary fever and electrolyte imbalance, seizure activities occurring during hospitalization and rash. Although the differences were statistically insignificant, moderate or severe unilateral or bilateral sensorineural hearing loss at 6 weeks and the overall neurologic sequelae, including hearing loss, at 1 year were higher in the placebo group, at 23% vs. 7.4% (P = 0.11) and 26.9% vs. 7.4% (P = 0.062), respectively. At 3 months after discharge, because of the improvement in hearing loss in one dexamethasone-treated patient the incidence of hearing impairment was significantly less than that in the placebo group, at 3.7% vs. 23%, respectively (P = 0.044). No improvement in hearing loss was observed after 3 months.(ABSTRACT TRUNCATED AT 250 WORDS)