Glycerol in bacterial meningitis: one strike and out?

Abstract

Bacterial meningitis is ten-times more common in sub-Saharan Africa than in other parts of the world. 1 Scarborough M Thwaites GE The diagnosis and management of acute bacterial meningitis in resource-poor settings. Lancet Neurol. 2008; 7: 637-648 Summary Full Text Full Text PDF PubMed Scopus (84) Google Scholar In this region, the death toll is as high as 50% owing to a high rate of HIV infection, malnutrition, antibiotic-resistant bacteria, and poor access to health care. 1 Scarborough M Thwaites GE The diagnosis and management of acute bacterial meningitis in resource-poor settings. Lancet Neurol. 2008; 7: 637-648 Summary Full Text Full Text PDF PubMed Scopus (84) Google Scholar Randomised clinical trials have shown that adjunctive dexamethasone has no beneficial effect for bacterial meningitis in populations with a high rate of HIV infection. 2 Scarborough M Gordon SB Whitty CJ et al. Corticosteroids for bacterial meningitis in adults in sub-Saharan Africa. N Engl J Med. 2007; 357: 2441-2450 Crossref PubMed Scopus (196) Google Scholar , 3 Molyneux EM Walsh AL Forsyth H et al. Dexamethasone treatment in childhood bacterial meningitis in Malawi: a randomised controlled trial. Lancet. 2002; 360: 211-218 Summary Full Text Full Text PDF PubMed Scopus (247) Google Scholar , 4 Brouwer MC McIntyre P de Gans J Prasad K van de Beek D Corticosteroids for acute bacterial meningitis. Cochrane Database Syst Rev. 2010; 9 (CD004405) PubMed Google Scholar Therefore, adjunctive therapies are urgently needed to improve the prognosis of bacterial meningitis in this setting. Glycerol has been suggested as one of the candidate therapies. Glycerol is a hyperosmolar agent that has been used in several neurological and neurosurgical disorders to decrease intracranial pressure. 5 van de Beek D Weisfelt M de Gans J Tunkel AR Wijdicks EF Drug insight: adjunctive therapies in adults with bacterial meningitis. Nat Clin Pract Neurol. 2006; 2: 504-516 Crossref PubMed Scopus (39) Google Scholar Although glycerol has no beneficial effect in experimental meningitis models, 6 Blaser C Klein M Grandgirard D et al. Adjuvant glycerol is not beneficial in experimental pneumococcal meningitis. BMC Infect Dis. 2010; 10: 84 Crossref PubMed Scopus (18) Google Scholar randomised clinical trials in Finland 7 Kilpi T Peltola H Jauhiainen T Kallio MJ Oral glycerol and intravenous dexamethasone in preventing neurologic and audiologic sequelae of childhood bacterial meningitis. The Finnish Study Group. Pediatr Infect Dis J. 1995; 14: 270-278 Crossref PubMed Scopus (88) Google Scholar and South America 8 Peltola H Roine I Fernandez J et al. Adjuvant glycerol and/or dexamethasone to improve the outcomes of childhood bacterial meningitis: a prospective, randomized, double-blind, placebo-controlled trial. Clin Infect Dis. 2007; 45: 1277-1286 Crossref PubMed Scopus (143) Google Scholar suggested that this drug might protect against sequelae in children with bacterial meningitis. Glycerol adjuvant therapy in adults with bacterial meningitis in a high HIV seroprevalence setting in Malawi: a double-blind, randomised controlled trialOral glycerol therapy cannot be recommended as an adjuvant therapy in adults with bacterial meningitis in resource-poor settings with a high HIV prevalence. Full-Text PDF