DEXAMETHASONE THERAPY FOR BACTERIAL-MENINGITIS IN CHILDREN

Routine use of steroids as adjunctive treatment of bacterial meningiti s remains controversial. We have carried out a prospective, placebo-co ntrolled, double-blind study of dexamethasone in 115 children with acu te bacterial meningitis in Switzerland. The patients were randomly ass igned to receive either placebo (n = 55) or dexamethasone (n = 60) in addition to optimum antibiotic treatment (100 mg/kg daily ceftriaxone) . Dexamethasone therapy (0.4 mg/kg) was started 10 min before the firs t dose of ceftriaxone and given every 12 h for 2 days. Baseline demogr aphic, clinical, and laboratory features of the two groups were simila r. After 24 h treatment meningeal inflammation as shown by cerebrospin al fluid (CSF) glucose concentration was significantly less with dexam ethasone than with placebo (mean increase in glucose 63 [76]vs 40 [75] %, p=0 008). However, other indices of inflammation showed similar cha nges in both groups. Addition of dexamethasone did not affect the rate at which CSF became sterile. Both groups showed prompt clinical respo nses and similar frequencies of complications (15 vs 12%). Monitoring for possible adverse effects of dexamethasone revealed no abnormalitie s. At follow-up examinations 3, 9, and 15 months after hospital discha rge, 9 (16%) of 55 placebo recipients and 3 (5%) of 60 dexamethasone r ecipients had one or more neurological or audiological sequelae (p=0.0 66); the relative risk of sequelae was 3.27 (95% Cl 0.93-11.47). Our r esults and those of similarly designed studies lead us to believe that adjunctive dexamethasone therapy improves outcome from bacterial meni ngitis in infants and children. We recommend its use, preferably in th e dose regimen used in this study.