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Dexamethasone and bacterial meningitis in Pakistan
1Children's Hospital, Pakistan Institute of Medical Sciences, Islamabad, Pakistan.
Insights
Dexamethasone did not improve outcomes for children with bacterial meningitis in a developing country. The study found no benefit in mortality or neurological and hearing impairments for this patient group.
Area of Science:
- Pediatrics
- Infectious Diseases
- Clinical Pharmacology
Background:
- Bacterial meningitis remains a significant cause of childhood mortality and morbidity globally.
- Adjunctive therapies like corticosteroids are explored to improve outcomes.
- The efficacy of dexamethasone in developing countries for bacterial meningitis is not well-established.
Purpose of the Study:
- To evaluate the effect of dexamethasone on bacterial meningitis outcomes in children within a developing country.
- To assess the impact of dexamethasone on mortality, neurological sequelae, and hearing impairment.
Main Methods:
- A prospective, double-blind, placebo-controlled trial involving 89 children (2 months to 12 years) with bacterial meningitis.
- Patients received either dexamethasone or placebo alongside standard antimicrobial treatment (ampicillin and chloramphenicol).
- Neurological, developmental, and hearing assessments were performed at 1, 4, and 12 months post-discharge.
Main Results:
- Mortality was higher in the dexamethasone group (25%) compared to the placebo group (12%).
- Dexamethasone survivors showed similar rates of neurological sequelae (26.5% vs. 24%) and higher hearing impairment (42.3% vs. 30%) than placebo survivors.
- Late presentation and impaired consciousness were independent predictors of death.
Conclusions:
- Dexamethasone therapy provided no beneficial effect on morbidity or mortality in this cohort of seriously ill bacterial meningitis patients in a developing country.
- The use of dexamethasone as adjunctive treatment is not recommended for bacterial meningitis patients in developing countries, especially those presenting late or partially treated.
Abstract:
The objective of this study was to assess, in a developing country setting, the effect of dexamethasone therapy on bacterial meningitis outcomes. A prospective double blind placebo controlled trial was conducted in 89 children aged from 2 months to 12 years suffering from bacterial meningitis. Neurological, developmental, and hearing assessments were conducted at one, four, and 12 months after discharge. Forty eight patients received dexamethasone and 41 placebo. Initial antimicrobial drugs used were ampicillin and chloramphenicol. For all patients at the time of admission the mean duration of illness was 5.7 days; 47% had had seizures and 56% had impaired consciousness. Seventeen of 89 (19%) patients died. The mortality for the dexamethasone group was 25% as compared with 12% in the group receiving placebo. Presentation to the hospital after four days of symptoms and with impaired conscious state were independent predictors of death. Of the dexamethasone group survivors, 26.5% had neurological sequelae and 42.3% had hearing impairment, whereas in the placebo group it was 24% and 30% respectively. Altered state of consciousness was a predictor of neurological sequelae. The presence of neurological sequelae and high cerebrospinal fluid protein independently predicted hearing loss. No beneficial effect of dexamethasone was observed on morbidity or mortality of this group of patients with bacterial meningitis. Dexamethasone is therefore not useful in developing countries as adjunctive treatment in patients seriously ill with bacterial meningitis, who present late for treatment and have been partially treated.