Nationwide implementation of adjunctive dexamethasone therapy for pneumococcal meningitis

Abstract

This study provides Class III evidence that dexamethasone (10 mg IV, given every 6 hours for 4 days started before or with the first dose of parenteral antibiotics) reduced the proportion of patients with unfavorable outcomes (Glasgow Outcome Scale score of 1 to 4) in the 2006-2009 cohort, as compared to the 1998-2002 cohort (39% vs 50%; OR 0.63; 95% CI 0.46-0.86; p = 0.002). Mortality rate (20% vs 30%; absolute risk difference 10%; 95% CI 4%-17%; p = 0.001) was also lower in 2006-2009.

Bacterial meningitis in solid organ transplant recipients: a population‐based prospective study

“…Methods have been described previously 6. From this cohort study, we selected all patients with a medical history of solid organ transplantation.…”

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

“…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).…”

“…Two (co)primary outcomes were defined: a) proportion of patients with GOS=1 (i.e., mortality); b) proportion of patients with GOS=5 (i.e., full recovery, as opposed to unfavourable outcomes: GOS <5). The interobserver agreement of GOS is high (7).…”

“…We used the Glasgow Outcome Scale (GOS) score as a measure of disease outcome, as assessed at discharge/end of specific treatment for meningitis (7,14). GOS grades the outcomes as: death (GOS=1); vigil coma (GOS=2); conscious with severe neurological deficit (dependent) (GOS=3); moderate disability (independent, professionally incapable) (GOS=4) and independent, professionally capable, no or minor disability (GOS=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). On the other hand, recent meta-analyses of placebo-controlled trails indicate that the effect of early dexamethasone in adults is seemingly less robust than theoretically expected, and might be affected by trial quality, socio-economic level of the country (reflecting on access to medical care, HIV infection prevalence and treatment possibilities, but probably also on other factors), causative agent and level of evidence of bacterial infection (5,(8)(9)(10).…”