Focus on Dexamethasone in the treatment of meningitis
- Adjunctive dexamethasone therapy has been used in the treatment of meningitis for at least thirty years.
- There have been many studies into the effects of dexamethasone therapy. These studies have produced conflicting results, with some demonstrating beneficial effects and some demonstrating no benefit or even detrimental effects.
- A meta-analysis of all clinical studies between 1988 and 1996 confirmed the benefit of adjunctive treatment with dexamethasone in children who had meningitis caused by Haemophilus influenzae type b. (1.)
- The results of the analysis also suggested a benefit in children with Streptococcus pneumoniae meningitis if treatment was initiated with or before parenteral antimicrobial therapy. (1.)
- A European study, between 1993 and 2001, investigated the use of dexamethasone in adults (aged 17 and over) with suspected bacterial meningitis. The study was randomised, double-blind and placebo-controlled. (2.)
- The results of the study can be summarised as follows:
 Mortality was lower in the group treated with dexamethasone.- The incidence of impaired consciousness, seizures and cardio respiratory failure was lower in the dexamethasone group.
- Dexamethasone therapy caused a significant reduction in unfavourable outcomes only in patients with meningitis caused by S. pneumoniae.
- No apparent benefit of dexamethasone therapy was noted in patients with meningococcal meningitis.
- Dexamethasone did not reduce the incidence of neurologic sequelae, including hearing loss.
- On the basis of the results from this study and other studies, the following recommendations can be made:
- The routine use of dexamethasone therapy is warranted in most adults with suspected pneumococcal meningitis.
- The dexamethasone can be given with or before the first dose of antimicrobial agent.
- Dexamethasone therapy is not recommended in patients with septic shock if they have adequate adrenal reserve. (3.)
- If meningitis is found not to be caused by S. pneumoniae, dexamethasone therapy should be discontinued.
The use of dexamethasone in the treatment of meningitis requires further study. Areas that need further study include its use in the treatment of meningitis caused by different micro-organisms and occurring in different age groups.
References
1.McIntyre PB, Berkley CS, King SM, Schaad UB, Kilpi T, Kanra GY, et al. Dexamethasone as adjunctive therapy in bacterial meningitis. A meta-analysis of randomized clinical trials since 1988. JAMA 1997; 278(11): 925-31
2. de Gans J., van de Beek D., Dexamethasone in adults with bacterial Meningitis. N Engl J Med 2002; 347: 1549-56
3. Abraham E., Evans T. Corticosteroids and septic shock. JAMA 2002; 288: 886-7
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