Steroids in Bacterial Meningitis
The Article: Adjunctive Dexamethasone in Bacterial Meningitis: A Meta-analysis of Individual Patient Data.Van De Beek et al. The Lancet Neurology 2010;9: 254-63
The Goal: To identify which subgroups of patients with bacterial meningitis would benefit most from dexamethasone therapy.
The Study: A meta-analysis of individual patient data from randomised, double-blind, placebo-controlled trials of dexamethasone use for treatment of bacterial meningitis in patients of all ages. The outcome measures were death at time of first follow up, death or severe neurological sequelae at one month follow up, death or any neurological sequelae at first follow up, and death or severe bilateral follow up at first follow up.
Findings: 1) When compared to placebo, adjunctive dexamethasone treatment in BM exhibited no significant reduction in: death, death or severe neurological sequelae, death or any neurological sequelae, or death and bilateral hearing loss.
2) Dexamethasone did show a reduction in the number of surviving patients with bilateral hearing loss.
3) Dexamethasone had no effect in the specified patient subgroups including HIV status, age, specific causative organisms, or pre-dexamethasone antibiotic treatment.
Takeaway: Even though there was no significant mortality benefit of adjunctive dexamethasone treatment in treatment of bacterial meningitis, there is a benefit in reducing bilateral hearing loss in survivors. In combining these results with those from older trials, there were no significant adverse effects of using dexamethasone as a part of a bacterial meningitis treatment regimen. This study is limited by a pooling of data from five very heterogeneous patient populations (Europe, Vietnam, Malawi adult, Malawi child, South America); there may still be a mortality benefit of dexamethasone use among certain larger, more homogeneous, patient populations.