子どもにおける細菌性髄膜炎に対するデキサメタゾン療法. スイスの髄膜炎研究グループ
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U B Schaad1, U Lips, H E Gnehm
1Department of Pediatrics, University of Berne, Switzerland.
Lancet (London, England)
|August 21, 1993
まとめ
細菌性髄膜炎の小児におけるデキサメタゾンの補助療法は,髄膜炎の炎症と長期的な神経学的後遺症を著しく減少させた. この研究は,小児性細菌性髄膜炎の改善のためのデキサメタゾンの日常的な使用を支持しています.
科学分野:
- 小児の感染症について
- 臨床薬理学 臨床薬理学とは
- 神経科学は神経科学である.
背景:
- バクテリア性髄膜炎の補助治療としてステロイドの日常的な使用は議論されています.
- 細菌性髄膜炎は,小児において重度の神経学的合併症を引き起こす可能性があります.
研究 の 目的:
- 子どもにおける急性細菌性髄膜炎の補助療法としてのデキサメタゾンの有効性と安全性を評価する.
- デキサメタゾンが炎症,CSFの不妊化,臨床反応,および長期的後遺症に及ぼす影響を評価する.
主な方法:
- 急性細菌性髄膜炎を患っている115人の子どもを対象とした前向き,プラセボ対照,ダブルブラインド試験です.
- 患者はセフトリアキソンと併用してプラセボまたはデキサメタゾン (2日間12時間毎に0.4mg/kg) を投与された.
- 測定されたアウトカムには,CSFのグルコース濃度,CSFの滅菌,臨床反応,合併症,およびフォローアップ時の神経学的/聴覚学的続変が含まれています.
主要な成果:
- デキサメタゾンは,プラセボと比較して24時間後に髄膜炎症 (CSFグルコース濃度) を著しく減少させた (p=0.008).
- グループ間のCSFの滅菌率,臨床応答,または合併症の頻度において有意な差異は観察されなかった.
- デキサメタゾンを投与した患者では,退院後3,9,15ヶ月で神経学的または聴覚学的続変が少ない (5%対16%).
結論:
- 補助的なデキサメタゾン療法により,細菌性髄膜炎の乳児および小児のアウトカムが改善されます.
- この研究では,長期にわたる神経学的欠陥を軽減するために,デキサメタゾンの使用,特に研究されたレジメンの使用を推奨しています.
- デキサメタゾンは安全であることが判明し,このコホートでは有害事象が観察されませんでした.
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