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Change policy: Giving steroids to children with meningitis can reduce hearing loss and lower the incidence of long-term brain damage and can save lives in both children and adults with meningitis
July 28, 2003Research News in the Cochrane Database of Systematic Reviews
Antibiotics are essential and life-saving in the treatment of bacterial meningitis, but for years doctors have debated whether to give corticosteroids at the same time. The inflammation caused by meningitis can actually be made worse by antibiotics in the short term, as the bacteria killed by antibiotics release various toxins. Experimental evidence showed that steroids reduce this inflammation, which carries with it the risk of permanent brain damage and/or deafness from impaired blood supply.
Many controlled trials in humans have looked at the effect of adding corticosteroid therapy to antibiotics in acute bacterial meningitis, but each trial on its own has not given conclusive results.
A review published in the August update of the Cochrane Database of Systematic Reviews settles the argument. Giving corticosteroids with antibiotics more than halves the number of children who suffer from severe hearing loss - a reduction from 8% to 3%. The effect on reducing deaths and brain damage was less dramatic, but even so, in both cases children benefited from using the two drugs together.
For adults with bacterial meningitis, giving corticosteroids would save one life for every 10 patients treated - a reduction from 18 to 8%.
"Our analysis of currently available data shows that there is strong evidence for giving corticosteroids to children suspected of having bacterial meningitis", says lead author, Dr Diederik van de Beek of the Department of Neurology at the Academic Medical Center University of Amsterdam.
This authoritative review was compiled with the help of an international team involving Dr Jan de Gans from the Netherlands, Prof Peter McIntyre from Australia, and Prof Kameshwar Prasad from India.
They recommend that, in developed countries, patients are given a four-day course of dexamethasone (0.6mg/kg daily). As it is important to give the first steroid dose before, or at least with, the first dose of intravenous antibiotics in hospital, use of dexamethasone is less applicable in countries where there is likely to be a significant delay before hospital treatment.
John Wiley & Sons
A review published in the August update of the Cochrane Database of Systematic Reviews settles the argument. Giving corticosteroids with antibiotics more than halves the number of children who suffer from severe hearing loss - a reduction from 8% to 3%. The effect on reducing deaths and brain damage was less dramatic, but even so, in both cases children benefited from using the two drugs together.
For adults with bacterial meningitis, giving corticosteroids would save one life for every 10 patients treated - a reduction from 18 to 8%.
"Our analysis of currently available data shows that there is strong evidence for giving corticosteroids to children suspected of having bacterial meningitis", says lead author, Dr Diederik van de Beek of the Department of Neurology at the Academic Medical Center University of Amsterdam.
This authoritative review was compiled with the help of an international team involving Dr Jan de Gans from the Netherlands, Prof Peter McIntyre from Australia, and Prof Kameshwar Prasad from India.
They recommend that, in developed countries, patients are given a four-day course of dexamethasone (0.6mg/kg daily). As it is important to give the first steroid dose before, or at least with, the first dose of intravenous antibiotics in hospital, use of dexamethasone is less applicable in countries where there is likely to be a significant delay before hospital treatment.
John Wiley & Sons
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