Dexamethasone as an adjunctive treatment of bacterial meningitis

Abstract

This study was conducted on 77 Libyan infants and children aged month to 10 years with acute bacterial meningitis. Upon admission, the patients were divided randomly in two groups. Group I (38 patients) received ceftriaxone plus dexamethasone i.v. Group II (39 patients) received ceftriaxone alone. Both groups were compared for mean changes in CSF sugar, CSF protein and CSF polymorph count at 4th day of treatment. There was a significant difference between the two groups in CSF sugar and protein changes (P < 0.05) but not in CSF polymorph (P > 0.05). Both groups showed prompt clinical response and similar occurrence of acute complications, fatality rate and permanent neurological sequelae. However, group I manifested shorter duration of fever (P < 0.05). Dexamethasone improved the inflammatory reaction in acute bacterial meningitis and shortened the duration of fever but it did not have any significant effect on the fatality and the occurrence of neurological sequelae of this disease.

The role of dexamethasone in the treatment of bacterial meningitis – a systematic review

“…reported no effect of dexamethasone (any neurological deficit at 3 or 6 months, 10 vs. 8%; any auditory deficit, 7 vs. 21%). Three studies from Pakistan, Libya, and India, respectively, reported no consistent effect on mortality, neurological (27 vs. 24%, 13 vs. 10%, and 21 vs. 13%, respectively), or auditory deficits (39 vs. 16%, no data, and 29 vs. 19%). Additionally, the study by Thomas et al.…”

“…The search resulted in 942 hits. From this search and from references in the studies identified by the search, 44 publications reporting clinical trials of relevance were identified, comprising 29 reports on randomised studies (in which group allocation is based on a non‐systematic, random allocation of patients, such as by a random sequence generation on a computer) . Of the publications reporting randomised studies, one included two studies, whereas three publications reported follow‐up data based on previously published trials.…”

The effects of adding glucocorticosteroids to standard care for children with sepsis. A systematic review of randomized clinical trials with meta-analysis and Trial Sequential Analysis

“…All the trials assessed glucocorticosteroids as add on therapy of standard care. The glucocorticosteroids included were hydrocortisone (8 trials) (27,42,43,(46)(47)(48)(49)(50); dexamethasone (15 trials) (28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)43); and methylprednisolone (1 trial) (45) ( Table 1). 18 trials used placebo plus standard care (27-31, 33, 35-37, 40-43, 45, 46, 48, 49) and 6 trials used only standard care as control intervention (16,25,32,34,38,47).…”

“…The age groups of the randomized participants were infants (< 1 year) (38,43,44,47) and children (age > 1 year and < 12 years) (27-37, 39-42, 45, 47, 48). All the trials assessed glucocorticosteroids as add on therapy of standard care.…”