Adjunctive dexamethasone in meningitis: does value depend on clinical setting?

Abstract

Bacterial meningitis causes 170 000 deaths worldwide per year and, in low-income and middle-income countries, is ranked fourth as a cause of disability, 1 Murray CJ Lopez AD Mathers CD Stein C The Global Burden of Disease 2000 project: aims, methods and data sources. World Health Organization, 2001http://www.who.int/healthinfo/paper36.pdf Google Scholar emphasising the need for clear evidence-based recommendations to guide acute management. Despite more than 20 clinical trials of adjunctive corticosteroid therapy in bacterial meningitis over the past 50 years, 2 van de Beek D de Gans J McIntyre P Prasad K Corticosteroids for acute bacterial meningitis. Cochrane Database Syst Rev. 2003; 3 (CD004405.) PubMed Google Scholar absence of significant benefit in most individual studies, diverse steroid and antibiotic regimens, and concerns about generalisability to all causative organisms have fuelled continued debate. A Cochrane review on bacterial meningitis, based on trials reported to the end of 2003, concluded that use of adjunctive dexamethasone in bacterial meningitis was justified in all adults but only in children in high-income countries. 2 van de Beek D de Gans J McIntyre P Prasad K Corticosteroids for acute bacterial meningitis. Cochrane Database Syst Rev. 2003; 3 (CD004405.) PubMed Google Scholar It called for additional studies among adults in low-income countries and for a meta-analysis of data on individual patients, to increase understanding of the heterogeneous findings in children from low-income and high-income countries. Adjunctive dexamethasone in bacterial meningitis: a meta-analysis of individual patient dataAdjunctive dexamethasone in the treatment of acute bacterial meningitis does not seem to significantly reduce death or neurological disability. There were no significant treatment effects in any of the prespecified subgroups. The benefit of adjunctive dexamethasone for all or any subgroup of patients with bacterial meningitis thus remains unproven. Full-Text PDF Open Access