Influence of Dexamethasone on the Clinical Course of Bacterial Meningitis in Children

Abstract

Of pediatric patients with purulent meningitis seen at the institutions listed in the title page of this paper between 1986 and 1994, 93 patients treated with antibiotics and dexamethasone (DXM) were compared with 91 patients treated with antibiotics alone. The patients receiving antibiotics with dexamethasone achieved overall improvement in inflammatory symptoms and signs and cerebrospinal fluid findings and became afebrile significantly earlier than those receiving antibiotics alone. However, some of the patients became febrile again. The secondary fever rate for the DXM group was much higher than that for the antibiotic alone group (p < 0.0001). In most of the rebounded cases, the body temperature rose above 38 degrees C and remained elevated for 2-4 days. Cerebrospinal fluid (CSF) was cultured daily in 54 and 32 patients receiving antibiotics with and without DXM, respectively. Although this study was not a controlled study in a strict sense, these patients compared. In both groups, the CSF became mostly culture-negative within 48 hours. In a few patients receiving DXM, however, it became culture-negative after 72 hours or longer. DXM caused an adverse effect in a patient with meningitis caused by Streptococcus pneumoniae. The adverse effect was mild gastrointestinal bleeding, which recovered spontaneously. From the findings described above, the use of DXM combined with antibiotic therapy was considered to accelerate the relief from fever and improvement of inflammatory symptoms and signs and CSF findings. The body temperature rose again in more than half of the patients receiving DXM, but fell to normal spontaneously without treatment. The elevation doubtlessly could not be distinguished from recurrence of the meningitis itself or complications. It seems to be likely that no treatment but careful observation is required even if the fever recurs as far as the CSF findings showed favorable progress with excelluent general conditions. When DXM is given, it is essential that CSF tests and culture are repeated during the early stages and the progress is monitored carefully.

Blood-brain barrier damage as a predictor of outcome in patients with purulent meningitis

“…Moreover, animal and human investigations have found that the use of dexamethasone improves the BBB damage and reduces neurological complications and CSF inflammation [1,2,14,17,19,22,25,30]. According to our data, the BBB damage is intensive during purulent meningitis and it constitutes a sensitive parameter in the outcome of the disease [6,14,21,25,29,31].…”

“…The reference value of the albumin coefficient was 1.8-7.4 × 10 -3 . An albumin coefficient value less than 9 is considered normal, a value of 10-14 indicates mild BBB dysfunction, 15-30 severe BBB dysfunction, 31-100 very severe BBB dysfunction, and if it is greater than 100, it indicates complete collapse of BBB functions [25,26].…”

“…Recently, studies covering high income countries have reported that the use of dexamethasone reduces hearing loss and neurological sequelae, increases recurrent fever and has no effect on the mortality rate from bacterial meningitis [24,25]. It has to be emphasized that the abovementioned clinical and animal studies use protein and CSF glucose concentrations as markers to determine the degree of BBB damage.…”