The Role of Steroids in the Management of Children with Bacterial Meningitis

Abstract

The article by Wald et al in this issue of Pediatrics addresses the potential value of adjunctive steroid therapy in the management of bacterial meningitis in children older than 8 weeks of age.1 This carefully designed and executed multicenter, randomized, controlled trial (RCT) compared the hospital course and long-term outcome of 69 dexamethasone recipients with that of 74 well-matched placebo recipients. The dose of steroids was the same as that used in three prior RCTs2,3 and the first dose was administered within 4 hours after the first dose of ceftriaxone. Unique to this study was the performance of the first audiologic evaluation within 24 hours of admission to the hospital, permitting the investigators to determine the time of onset of the most common sequela of meningitis, sensorineural hearing loss.