DEXAMETHASONE
IN ADULTS WITH BACTERIAL MENINGITIS.
de Gans
J, et al. N Engl J Med 2002 Nov 14;347(20):1549-56.
BACKGROUND:
Mortality and morbidity rates are high among adults with acute bacterial
meningitis, especially those with pneumococcal meningitis. In studies of
bacterial meningitis in animals, adjuvant treatment with corticosteroids has
beneficial effects.
METHODS:
We conducted a prospective, randomized, double-blind, multicenter trial of
adjuvant treatment with dexamethasone, as compared with placebo, in adults with
acute bacterial meningitis. Dexamethasone (10 mg) or placebo was administered
15 to 20 minutes before or with the first dose of antibiotic and was given
every 6 hours for four days. The primary outcome measure was the score on the
Glasgow Outcome Scale at eight weeks (a score of 5, indicating a favorable
outcome, vs. a score of 1 to 4, indicating an unfavorable outcome). A subgroup
analysis according to the causative organism was performed. Analyses were
performed on an intention-to-treat basis.
RESULTS:
A total of 301 patients were randomly assigned to a treatment group: 157 to the
dexamethasone group and 144 to the placebo group. The base-line characteristics
of the two groups were similar. Treatment with dexamethasone was associated
with a reduction in the risk of an unfavorable outcome (relative risk, 0.59; 95
percent confidence interval, 0.37 to 0.94; P=0.03). Treatment with
dexamethasone was also associated with a reduction in mortality (relative risk
of death, 0.48; 95 percent confidence interval, 0.24 to 0.96; P=0.04). Among
the patients with pneumococcal meningitis, there were unfavorable outcomes in
26 percent of the dexamethasone group, as compared with 52 percent of the
placebo group (relative risk, 0.50; 95 percent confidence interval, 0.30 to
0.83; P=0.006). Gastrointestinal bleeding occurred in two patients in the
dexamethasone group and in five patients in the placebo group.
CONCLUSIONS:
Early treatment with dexamethasone improves the outcome in adults with acute
bacterial meningitis and does not increase the risk of gastrointestinal
bleeding.