Trial of dexamethasone treatment for severe bacterial meningitis in adults

Abstract

Bacterial meningitis is still a severe disease in adults, since the overall observed rate of death or severe neurologic sequelae was 26.7%. The reported data are inconclusive regarding a systematic use of dexamethasone as an adjunctive therapy for bacterial meningitis in adults. Moreover this treatment impairs antibiotic penetration into the cerebrospinal fluid (CSF) that can lead to therapeutic failure, particularly in areas with high or increasing rates of penicillin-resistant S. pneumoniae.

Prospects for Vaccine Prevention of Meningococcal Infection

“…Although there are limited data on the use of activated protein C in meningococcal infection, its use is appropriate if the exclusion criteria of the Protein C Worldwide Evaluation in Severe Sepsis trial are utilized (5,19,247,291 The administration of corticosteroids in patients with sepsis or bacterial meningitis remains controversial (80,344,354). In one study, patients with pneumococcal but not meningococcal meningitis appeared to benefit from steroid therapy, although the study did not have a sufficient sample size to demonstrate efficacy for specific pathogens other than S. pneumoniae (80).…”

Dexamethasone Aggravates Hippocampal Apoptosis and Learning Deficiency in Pneumococcal Meningitis in Infant Rats

“…Furthermore, H. influenzae meningitis has virtually disappeared in countries that have implemented programs with conjugated vaccines in infants and children (13). Consequently, the use of dexamethasone has remained controversial (12,14,15). Two brain structures prominently affected in bacterial meningitis are the cortex and the hippocampus.…”

Role of Dexamethasone in Meningitis

“…It may also impair antibiotic penetration into the cerebrospinal fluid (CSF) that can lead to therapeutic failure, particularly in areas with increasing rates of penicillin-resistant S. pneumonia. (Thomas R et al, 1999).…”