DEXAMETHASONE TREATMENT FOR ACUTE BACTERIAL-MENINGITIS - HOW STRONG IS THE EVIDENCE FOR ROUTINE USE

A methodological appraisal of the published randomised controlled tria ls on the use of dexamethasone as an adjunct treatment in acute bacter ial meningitis was carried out to examine whether the available eviden ce is strong enough to support the routine use of the drug. Studies we re eligible for inclusion if they were published in indexed journals a fter 1966, written in English, and were randomised controlled trials w ith dexamethasone as adjunct to antimicrobials in patients with acute bacterial meningitis. All studies were extracted and their adherence t o eight methodological principles was graded as adequate, inadequate, or unclear. A sensitivity analysis was done to examine the robustness of the conclusions. Seven studies met the eligibility criteria. No rep ort adhered to all the principles. Major threats to validity of the co nclusions included potential bias in analysis in all the studies, and lack of adjustment for baseline imbalances in four. Inadequate reporti ng of adverse effects hindered risk-benefit analysis. Sensitivity anal ysis showed that the numbers of patients withdrawn from analysis were enough to invalidate the conclusions. It is concluded that the availab le evidence is not strong enough to support a routine use of dexametha sone in acute bacterial meningitis. Further research is needed to dete rmine the effect of a policy to use dexamethasone early in the managem ent of suspected acute bacterial meningitis. Future studies should ado pt a pragmatic approach, be methodologically rigorous, and meticulousl y measure the risk as well as the benefit of this policy.