THE ROLE OF CORTICOSTEROID-THERAPY ON BAC TERIAL-MENINGITIS IN ADULTS

Most clinical trials on the efficacy of corticosteroid as adjuvant the rapy of community-acquired bacterial meningitis have been carried out in pediatric populations and thus in Haemophilus influenzae meningitis . The higher mortality rate and neurological sequela observed in adult s raised questions as to the efficacy of this treatment. As demonstrat ed in animal experimental models, some components of the Streptococcus pneumoniae cell wall have the same effects as the LPS of H. influenza e on the activation of the local inflammatory chain. Early administrat ion of dexamethasone reduces the consequences of the meningeal inocula tion particularly for cerebral edema. Data on patients sub-groups with pneumococcal meningitis, in a Cairo hospital, may suggest beneficial effect of early dexamethasone treatment on hearing sequela of pediatri c patients and on the mortality rate of adults patients. We carried ou t a randomized double-blind clinical trial on the efficacy of dexameth asone (10 mg q.i.d. during the first three days) in bacterial meningit is of adults treated with parental amoxicillin. Among the 60 included patients, 83% were hospitalized in an ICU and 43% required endotrachea l intubation. S. pneumoniae was isolated in 31 patients, with a reduce d susceptibility to penicillin in five cases, and Neisseria meningitid is in 18 patients. The overall cure rate-without any neurological sequ ela at day 30- was 51% in the placebo group and 74% in the dexamethaso ne group (NS). No major adverse effect was observed in the dexamethaso ne group and gastro-duodenal bleeding was observed in two patients of the placebo group. Indisputable group and gastro-duodenal bleeding was observed in two patients of the placebo group. Indisputable arguments on the efficacy of a complementary corticosteroid therapy in adult ba cterial meningitis are still lacking. This is due mostly to the absenc e of: well designed trials, or statistically relevant trials. The incr easing resistance of S. pneumoniae to betalactam antibiotics will prob ably delay answering this important question decrease the intra-mening eal diffusion of most available antibiotics and particularly impair th e diffusion of glycopeptides.