REBOUND FEVER IN BACTERIAL-MENINGITIS - ROLE OF DEXAMETHASONE DOSAGE

Since introducing dexamethasone as adjuvant therapy to antibiotics for bacterial meningitis, we have noticed an increase in the number of ca ses with secondary fever. Therefore, we performed a retrospective anal ysis of the 19 consecutive cases occurring during the last 5 years. Si x patients received dexamethasone for 4 days, 5 received a 2-day cours e of dexamethasone and 8 received antibiotics only. The etiologic agen ts included: Haemophilus influenzae (in 11 patients), Streptococcus pn eumoniae (in 6) and Neisseria meningitidis (in 2). Among the 11 patien ts receiving dexamethasone, the fever remitted within 1-5 days (averag e 1.7+/-1.2) while among the 8 patients not receiving dexamethasone th e initial fever lasted 1-17 days (average 5.3+/-1.7) (P=0.009). There was secondary fever without a definable clinical or bacteriological so urce in 9 of 11 patients receiving dexamethasone and in none of those who were treated without steroids (P<0.001). The secondary fever among those who received dexamethasone for 2 days was low grade (37.5 degre es-38 degrees C) and lasted for 1 day only, while among those who rece ived dexamethasone for 4 days it was >38 degrees C and more prolonged (7+/-2.3 days) (P<0.03). Total days of fever were 2.2+/-0.2 days when dexamethasone was administered for 2 days only vs. 7.8+/-1.7 for the p atients in each of the two other groups (P<0.03). The relatively benig n course with the 2-day regimen of dexamethasone makes us consider whe ther a 2-day course of dexamethasone might save costly evaluations of secondary fever and much concern. Further studies are needed in order to document the efficacy of this regimen in reducing neurological sequ elae.