Dexamethasone and bacterial meningitis in Pakistan.

Abstract

The objective ofthis 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. (Arch Dis Child 1996;75:482-488)

Dexamethasone Increases Hippocampal Neuronal Apoptosis in a Rabbit Model of Escherichia coli Meningitis

“…An E. coli K1-strain isolated from a child with neonatal meningitis (gift of Dr. G. Zysk, Institute of Medical Microbiology, Düssel-dorf, Germany) was cultured on blood agar plates at 37°C, harvested with 0.9% saline and preserved in aliquots containing 10 10 CFU/mL at -70°C. Minimal inhibitory concentration and minimal bactericidal concentration for ceftriaxone determined by broth microdilution were 0.0625 and 0.125 mg/L, respectively.…”

“…In the meningitis study, however, no reduction of the frequency of neurologic sequelae after the observation period of 8 wk could be demonstrated (8). The beneficial effect of adjunctive dexamethasone treatment observed in European countries was absent under the conditions of developing countries (9,10).…”

Reprogramming the Host Response in Bacterial Meningitis: How Best To Improve Outcome?

“…Adjuvant dexamethasone treatment did not result in an increased risk of serious adverse events, such as gastrointestinal bleeding. Studies in the developing world, where presentation to hospital is often delayed, showed that adjuvant steroid treatment could not improve outcome in this setting (96,123). These results indicate that corticosteroids are only beneficial when administered early in the course of the disease.…”

Revisão sistemática do uso da dexametasona como terapia adjuvante na meningite bacteriana em crianças

“…In another study published in 1996, Qazi et al analyzed 89 patients aged 2 months to 12 years with BM, selected from April 1990 to March 1992 in a pediatric hospital in Pakistan (26) . Children with kidney or liver disease, diseases of the central nervous system (epilepsy, hydrocephaly, previous history of meningitis, hearing loss, mental impairment) or a history of trauma were excluded.…”

“…(22)(23)(24)(25)(26) In 2007, Peltola et al published the results of a multicenter study conducted in ten Latin American countries from 1996 to 2003, including 654 children aged 2 months to 16 years with bacterial meningitis, no previous history of traumatic brain injury (TBI) and no recent neurosurgery, neurological disease, immunosuppression or hearing impairment known (23) . The diagnosis was defined by positive cerebrospinal fluid (CSF) culture for typical BM causative agent, characteristic biochemical and cytological findings on positive CSF and blood cultures, characteristic CSF biochemical and cytological findings associated to positive latex agglutination test or signs and symptoms consistent with meningitis associated with at least three of the following criteria: CSF pleocytosis (>1000cells/mm³); hypoglycorrhachia (<40mg/dL), hyperproteinorrhachia (>40mg/dL), increased C-reactive protein serum (>40mg/L).…”