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Dexamethasone in Adults with Community-Acquired Bacterial Meningitis

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Abstract

Bacterial meningitis in adults is a severe disease with high fatality and morbidity rates. Experimental studies have shown that the inflammatory response in the subarachnoid space is associated with an unfavourable outcome. In these experiments, corticosteroids, and in particular dexamethasone, were able to reduce the inflammatory cascades in the subarachnoid space. The use of corticosteroids as adjunctive therapy in adults with bacterial meningitis has been evaluated in six studies, performed over a time period of 40 years. Most studies on adjunctive dexamethasone therapy in adults with bacterial meningitis were limited by methodological flaws. In 2002, a study with sufficient statistical power to show significant differences was published. This European Dexamethasone Study showed that adjunctive dexamethasone therapy reduced the rate of unfavourable outcomes in adults with bacterial meningitis from 25% to 15%. In this study, adjunctive treatment with dexamethasone was given before or with the first dose of antibacterials, without serious adverse effects. A quantitative review showed a consistent beneficial effect of dexamethasone on mortality and a borderline statistical beneficial effect on neurological sequelae. On the basis of the available evidence, adjunctive dexamethasone therapy should be initiated before or with the first dose of antibacterials and continued for 4 days in all adults with suspected or proven bacterial meningitis, regardless of bacterial aetiology. In patients with both meningitis and septic shock, dexamethasone therapy cannot be unequivocally recommended, but the use of lower doses seems reasonable at present. Since prompt use of dexamethasone and appropriate antibacterials improves the prognosis of adults with bacterial meningitis, hospitals will require protocols to include dexamethasone with the initial antibacterial therapy.

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Acknowledgements

We are indebted to Dr Arie van der Ende of The Netherlands Reference Laboratory for Bacterial Meningitis for providing figure 1. Dr van de Beek received a research grant from the Meningitis Research Foundation UK. The authors have no potential conflicts of interest that that are relevant to the contents of the manuscript.

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  1. Department of Neurology, Centre of Infection and Immunity Amsterdam (CINIMA), Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands

    Diederik van de Beek & Jan de Gans

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Correspondence to Diederik van de Beek.

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van de Beek, D., de Gans, J. Dexamethasone in Adults with Community-Acquired Bacterial Meningitis. Drugs 66, 415–427 (2006). https://doi.org/10.2165/00003495-200666040-00002

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