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Strong Support for Steroid Use in Adults with Bacterial Meningitis

Adults with bacterial meningitis benefited from very early treatment with steroids.

Researchers have found that steroids limit brain damage in children with bacterial meningitis, but findings in adults are less clear. In this double-blind European trial, 301 patients (age, 17) with clinical illness and cerebrospinal-fluid parameters suggestive of bacterial meningitis were randomized to receive intravenous dexamethasone (10 mg) or placebo immediately before their first antibiotic doses and then every 6 hours for 4 days. Most patients received a penicillin for therapy.

During treatment, dexamethasone recipients were significantly less likely than placebo recipients to suffer seizures (5% vs. 12%), impaired consciousness (11% vs. 25%), and cardiorespiratory failure (10% vs. 20%). In an intent-to-treat analysis performed 8 weeks after enrollment, the proportion of patients with unfavorable outcomes (i.e., death or neurologic impairment ) was significantly lower in the dexamethasone group than in the placebo group (15% vs. 25%), as was the proportion of patients who died (7% vs. 15%). Dexamethasone was particularly effective in reducing mortality in the subgroup of 108 patients with pneumococcal meningitis (14% vs. 34%). Rates of adverse events such as gastrointestinal bleeding were similar in the 2 groups.

Comment: Editorialists cautiously hail this study as one that should change practice in adults with suspected bacterial meningitis, especially pneumococcal meningitis, provided that steroids are given as early as possible. They emphasize one important caveat: The findings might not apply to patients infected with penicillin-resistant organisms who are treated with vancomycin or other antibiotics, as anti-inflammatory treatment might reduce penetration of such antibiotics into the cerebrospinal fluid.

— Abigail Zuger, MD

Published in Journal Watch General Medicine November 22, 2002

Citation(s):

de Gans J and van de Beek D. Dexamethasone in adults with bacterial meningitis. N Engl J Med 2002 Nov 14; 347:1549-56.

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Tunkel AR and Scheld WM. Corticosteroids for everyone with meningitis? N Engl J Med 2002 Nov 14; 347:1613-5.

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