Giving adult patients a corticosteroid to treat bacterial meningitis may cut their risk of death and disability from the infection, according to a study in the New England Journal of Medicine.
Researchers looked at the effect of adding dexamethasone to standard antibiotic treatment (2002;347:1549-56). They randomly assigned 301 adult patients to take either dexamethasone or an inactive placebo along with antibiotic treatment.
The corticosteroid was given either just before or at the same time as the first antibiotic dose, and then every 6 hours for 4days. The researchers found that over 8 weeks the risk of death among the patients taking dexamethasone was less than half that of the control patients: 7% versus 15% of patients died (relative risk of death 0.48; 95% confidence interval 0.24 to 0.96).
Dexamethasone treatment was also linked with a lower risk of unfavourable outcomes, including moderate to severe disability.
“It is not only important to kill the bacteria with antibiotics, but it is also important to reduce the inflammation in the central nervous system,” said the study's lead author, Dr Jan de Gans, of the University of Amsterdam.
Given these new findings, Dr de Gans said that dexamethasone should be given to all patients with bacterial meningitis—with the drug being started before or along with the first antibiotic dose.
The benefit of dexamethasone was seen mainly in patients with meningitis caused by Streptococcus pneumoniae, as opposed to patients with meningococcal meningitis, caused by Neisseria meningitidis.
But Dr de Gans thought that patients with meningococcal meningitis should also be treated with dexamethasone.