STEROID-THERAPY FOR BACTERIAL-MENINGITIS IN CHILDREN - REVIEW OF THE LITERATURE

Steroid therapy, in combination with antibiotics for bacterial meningi tis in paediatric patients remains controversial. Steroids, and primar ily dexamethasone a very potent anti-inflammatory agent, regulate the liberation of various cytokines and inflammatory mediators such as pro staglandins, released during bacterial meningitis and leading to long term complications. Several clinical trials studying infants and child ren with bacterial meningitis due to Haemophilus influenzae have evalu ated the beneficial effects of the administration of dexamethasone at the onset of antibiotherapy and demonstrated that dexamethasone reduce d the risk of acquired sensorineural deafness (bilateral moderate or m ore severe hearing loss) and the incidence of neurological sequelae. L imited information is available for the other bacterial meningitis, al though meningococcal meningitis will become more frequent with the use of effective anti-Haemophilus vaccines. In addition some Streptococcu s pneumoniae are now resistant to Bird generation cephalosporins and t he use of dexamethasone in that case may be at risk. Finally, no evide nce is available for an effective role for dexamethasone in neonatal b acterial meningitis, although it is quite often administered in that a ge group.