BENEFICIAL-EFFECTS OF DEXAMETHASONE IN CHILDREN WITH PNEUMOCOCCAL MENINGITIS

Fifty-six children older than 2 years with meningitis caused by Strept ococcus pneumoniae were enrolled in a prospective, double blind, place bo-controlled trial to evaluate the efficacy of dexamethasone therapy in addition to antimicrobial therapy, Twenty-nine of 56 received dexam ethasone (0.6 mg/kg/day iv, divided into 4 daily doses for 4 days) and the remaining 27 received placebo, At the beginning of therapy the cl inical and laboratory characteristics of the patients in the treatment groups were comparable, except for the Glasgow coma score (P = 0.004) , which was lower in the dexamethasone group, Patients were examined d aily during hospitalization and 6 weeks after discharge from the hospi tal, Hearing was assessed 6 weeks after discharge by means of pure ton e audiometry, Two patients in the dexamethasone group and one patient in the placebo group died. There were no differences between the two g roups with regard to the duration of fever, the incidence of secondary fever and electrolyte imbalance, seizure activities occurring during hospitalization and rash, Although the differences were statistically insignificant, moderate or severe unilateral or bilateral sensorineura l hearing loss at 6 weeks and the overall neurologic sequelae, includi ng hearing loss, at 1 year were higher in the placebo group, at 23% vs , 7.4% (P = 0.11) and 26.9% vs, 7.4% (P = 0.062), respectively, At 3 m onths after discharge, because of the improvement in hearing loss in o ne dexamethasone-treated patient the incidence of hearing impairment w as significantly less than that in the placebo group, at 3.7% vs, 23%, respectively (P = 0.044). No improvement in hearing loss was observed after 3 months. We conclude that dexamethasone is beneficial with reg ard to hearing impairment in the treatment of children with pneumococc al meningitis.