DEXAMETHASONE THERAPY FOR CHILDREN WITH BACTERIAL-MENINGITIS

Objective. To determine whether treatment with dexamethasone and ceftr iaxone for children with bacterial meningitis reduces the frequency of either sensorineural hearing loss or other neurologic sequelae. Desig n. This was a prospective, multicentered, placebo-controlled clinical trial. Subjects were followed for 1 year. Setting. The study was condu cted in six children's hospitals located in Pittsburgh, Houston, Los A ngeles, Chicago, Washington, D.C., and Columbus, Ohio. Patients. Enrol led were 173 children, 8 weeks to 12 years of age, with suspected bact erial meningitis; 143 children were evaluable. Eighty-seven percent of patients were followed for at least 6 weeks to 3 months, and 67% were followed for 1 year. Interventions. Subjects were randomized to recei ve ceftriaxone with or without dexamethasone (0.15 mg/kg every 6 hours for 4 days). Auditory brainstem responses (ABR) were measured within 24 hours of admission. Main outcome measures. Hearing, development, an d neurologic sequelae were assessed at the time of discharge and 6 wee ks and 1 year later. Main results. One hundred forty-three patients (6 9 received dexamethasone and 74 received placebo) with bacterial menin gitis were evaluable: Haemophilus influenzae type b (83), Streptococcu s pneumoniae (33), Neisserin meningitidis (24), and three others. Over all, there was no significant difference in auditory outcome between d examethasone and placebo recipients. Twenty-two children had bilateral moderate or more severe hearing loss at the time of the first ABR. At follow-up, the resolution of hearing impairment was nearly identical for each group. Nine of ten children who remained persistently deaf we re deaf at the time of the first ABR. There were no differences in neu rologic or developmental outcome between groups. Conclusion. All but o ne child with persistent bilateral moderate or more severe hearing los s had demonstrable deafness at the time of the first ABR. Dexamethason e did not significantly improve audiologic, neurologic, or development al outcome in children with bacterial meningitis.