Dexamethasone in Adults with Bacterial Meningitis

Gans, Jan de; Beek, Diederik van de

doi:10.1056/nejmoa021334

Cited by 1,054 publications

(552 citation statements)

References 26 publications

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“…Finally, as in the published reports, S. pneumoniae was the most prevalent single causative agent in the current cohort, found in 43.1% of the overall patients and in 55% of those with bacteriologically proven disease (6,7). This is in agreement with the European trial (36% and 46%, respectively) and observational data (62% and 69%, respectively) (6,7).…”

Section: Socio-economic Level Of the Country Patient Characteristicssupporting

confidence: 91%

“…The presently observed lack of benefit of adjunctive iv dexamethasone is in contrast with the results of a double-blind placebo-controlled European trial (conducted between 1993 and 2001) that showed reduced mortality and increased full recovery (i.e., reduced "unfavourable outcome" defined as GOS<5) in adults with community-acquired BM (particularly pneumococcal) receiving a specific dexamethasone regimen: 10 mg iv 15-20 minutes before or with the first parenteral antibiotic dose, and every 6 hours thereafter, over 96 hours (6). It is also in contrast with the recent observational report from the Netherlands indicating that this regimen, when transferred to daily practice, might reduce mortality and increase the likelihood of full recovery from pneumococcal disease (7).…”

Section: Discussioncontrasting

confidence: 78%

“…The present analysis of our 20-year experience (January 1, 1990 -December 31, 2009) indicates no benefit of adjunctive intravenous (iv) dexamethasone in reducing mortality or increasing the likelihood of full recovery (GOS=5, in the literature commonly depicted as "favourable outcome", as opposed to GOS<5) in adult community-acquired BM, pneumococcal or caused by other common agents, in daily practice (6,9). It also indicates no predictive value of the standard on-admission CSF markers of subarachnoid inflammation for these two outcomes.…”

Section: Discussionmentioning

confidence: 68%

“…It is also in contrast with the recent observational report from the Netherlands indicating that this regimen, when transferred to daily practice, might reduce mortality and increase the likelihood of full recovery from pneumococcal disease (7). Several points need to be considered in an attempt to identify the reasons for discrepancy between the present and reported results (6,7).…”

Section: Discussionmentioning

confidence: 78%

“…However, clinical usefulness of corticosteroids in adult bacterial meningitis (BM) had long lacked sound empirical evidence (5). In 2002, a multicenter, randomized, placebo-controlled trial demonstrated the potential of an adjunctive intravenous dexamethasone regimen (10 mg immediately before or with the first parenteral antibiotic dose and every 6 hours thereafter, over 4 days) to reduce mortality and unfavourable outcomes in European adults with community-acquired BM, particularly those with pneumococcal disease (the most prevalent bacteriological form) (6). This particular schedule was recently reported to apparently improve the outcomes of pneumococcal diseases in daily practice in a developed European country (7).…”

Section: Introductionmentioning

confidence: 99%

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Dexamethasone for adult community-acquired bacterial meningitis: 20 years of experience in daily practice

et al. 2011

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Section: Socio-economic Level Of the Country Patient Characteristicssupporting

confidence: 91%

Section: Discussioncontrasting

confidence: 78%

Section: Discussionmentioning

confidence: 68%

Section: Discussionmentioning

confidence: 78%

Section: Introductionmentioning

confidence: 99%

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Dexamethasone for adult community-acquired bacterial meningitis: 20 years of experience in daily practice

et al. 2011

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Use of Corticosteroids in Treating Infectious Diseases

McGee¹

2008

Arch Intern Med

107

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linicians have generally avoided prescribing corticosteroids for active infection because of their known immunosuppressive effects and concern about long-term complications. We conducted a review of the published randomized, double-blind trials comparing corticosteroids and placebo in infections. Except in some trials of viral infections, sore throat, and cerebral cysticercosis, all patients also received active antimicrobial agents in addition to placebo or corticosteroids. For patients with bacterial meningitis, tuberculous meningitis, tuberculous pericarditis, severe typhoid fever, tetanus, or pneumocystis pneumonia with moderate to severe hypoxemia, treatment with corticosteroids improved patient survival (group 1 infections). For patients with bacterial arthritis, corticosteroids were also beneficial and reduced long-term disability (group 2 infections). For about a dozen other infections, corticosteroids significantly relieved symptoms (group 3 infections), and clinicians should consider using them if symptoms are substantial. Corticosteroids were harmful in 2 infections, viral hepatitis and cerebral malaria (group 5 infections). We conclude that corticosteroids are beneficial and safe for a wide variety of infections, although courses longer than 3 weeks should be withheld from patients with concomitant human immunodeficiency virus infection and low CD4 counts.

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