Adjunctive corticosteroids in adults with bacterial meningitis
- 55 Downloads
Bacterial meningitis is a complex disorder in which neurologic injury is caused, in part, by the causative organism and, in part, by the host’s own inflammatory response. In studies of experimental bacterial meningitis, adjuvant treatment with corticosteroids, specifically dexamethasone, has beneficial effects. On the basis of these experimental studies, several clinical trials were undertaken to determine the effects of adjunctive corticosteroids in patients with bacterial meningitis. On the basis of overall benefit without detrimental effects by subgroup analysis, dexamethasone therapy should be initiated before or with the first dose of antibiotic and should be continued in most patients with community-acquired acute bacterial meningitis. For patients with a low suspicion of meningitis but an urgent need for antibiotics before cerebrospinal fluid can be obtained, we recommend initiation of treatment with dexamethasone, with discontinuation of dexamethasone therapy as soon as the diagnosis has been excluded.
Unable to display preview. Download preview PDF.
References and Recommended Reading
- 4.Tunkel AR: Bacterial Meningitis. Philadelphia: Lippincott Williams & Wilkins; 2001.Google Scholar
- 6.van de Beek D, de Gans J, McIntyre P, Prasad K: Corticosteroids in acute bacterial meningitis. Cochrane Database Syst Rev 2003, CD004305.Google Scholar
- 7.de Gans J, van de Beek D: Dexamethasone in adults with bacterial meningitis. N Engl J Med 2002, 347:1549–1556. The European Dexamethasone Study is a landmark study on adjunctive corticosteroids in adults with bacterial meningitis. This randomized clinical trial showed adjunctive dexamethasone treatment to be beneficial in adults with bacterial meningitis.PubMedCrossRefGoogle Scholar
- 13.van de Beek D, de Gans J, Spanjaard L, et al.: Clinical features and prognostic factors in adults with bacterial meningitis. N Engl J Med 2004, 351:1849–1859. The Dutch Meningitis Cohort is the first large prospective study of clinical features and prognostic factors in adults with bacterial meningitis. Patients were included in this study before routine dexamethasone use.PubMedCrossRefGoogle Scholar
- 24.Weisfelt M, van de Beek D, de Haan RJ, de Gans J: Determinants for outcome in adults with bacterial meningitis treated with adjunctive dexamethasone. Intensive Care Med 2005, In press.Google Scholar
- 28.Bennett IL, Finland M, Hamburger M, et al.: The effectiveness of hydrocortisone in the management of severe infections. JAMA 1963, 183:462–465.Google Scholar
- 29.Bhaumik S, Behari M: Role of dexamethasone as adjunctive therapy in acute bacterial meningitis in adults. Neurol India 1998, 46:225–228.Google Scholar
- 36.Annane D, Bellissant E, Bollaert P, et al.: Corticosteroids for treating severe sepsis and septic shock. Cochrane Database Syst Rev 2004, CD002243.Google Scholar
- 39.King SM, Law B, Langley JM, et al.: Dexamethasone therapy for bacterial meningitis: better never than late? Can J Infect Dis 1994, 5:210–215.Google Scholar