Pediatric Bacterial Meningitis - Dexamethasone Therapy

Pediatric Bacterial Meningitis Treatment

Dexamethasone Therapy

Experimental studies have revealed a correlation between outcome and the severity of the inflammatory process in the subarachnoid space.[27] In animal models of bacterial meningitis, the use of dexamethasone has been associated with decreased inflammation, reduced cerebral edema and ICP, and lesser degrees of brain damage.

Subsequent controlled, double-blind clinical trials demonstrated the beneficial effects of adjunctive dexamethasone in infants and children with Hib meningitis. The incidence of neurologic and audiologic sequelae was significantly decreased on follow-up examination; clinical benefit was greatest for overall hearing impairment. As a result, the IDSA guidelines recommend adjunctive dexamethasone for these patients in a dosage of 0.15 mg/kg q6h for 2-4 days, initiated 10-20 minutes before (or at least concomitant with) the first antimicrobial dose.

A meta-analysis by Mongelluzzo et al did not find corticosteroids to be beneficial in children with bacterial meningitis.[28] Survival and time to hospital discharge did not differ significantly between the corticosteroid treatment group and the untreated group, even when the 2 groups were subcategorized according to age or causative organism.

A prospective, double-blind, placebo-controlled, multicenter trial in adults with bacterial meningitis documented benefit (a lower percentage of unfavorable outcomes, including death) in patients with pneumococcal meningitis but not in others. Although dexamethasone has not yet been convincingly shown to offer a clear clinical benefit in pediatric patients with S pneumoniae meningitis, a Cochrane review recommended that corticosteroids be considered in nonneonates with bacterial meningitis in high-income countries.[27]

Given the lack of a clear benefit favoring the use of dexamethasone in older infants and children and the concerns that such use may lead to decreased antibiotic penetration in the CSF, the decision to give dexamethasone must be made on a case-by-case basis after the potential risks and benefits have been carefully weighed. The data are likewise insufficient to allow recommendation of adjunctive steroid therapy in neonates with bacterial meningitis.