Fred A. Zar, MD, FACP
In patients with bacterial meningitis, does dexamethasone reduce mortality and neurologic sequelae? Is dexamethasone more effective in some patient subgroups?
Individual patient data meta-analysis of 5 randomized, placebo-controlled trials (RCTs) published after 2001. Individual patient data were not available from earlier RCTs.
Unclear allocation concealment.*
All trials were reported as double-blind.*
Hospital discharge, 1 month, or 8 weeks for primary study outcomes.
2 RCTs were done in Malawi, 1 in Europe, 1 in South America, and 1 in Vietnam.
2447 patients (age range 2 mo to > 16 y for 2029 with individual patient data) with clinically suspected bacterial meningitis and meeting cerebrospinal fluid criteria.
Dexamethasone (n = 1019), with a dose range between 0.15 mg/kg, 4 times daily for 2 days, and 10 mg, 4 times daily for 4 days; or placebo (n = 1010).
Included death or severe neurologic sequelae (including severe bilateral hearing loss) at 1 month, death at first follow-up, and death or any neurologic sequelae (including any hearing loss) at first follow-up. Subgroup analyses of 15 variables were specified before data were collated.
83% of eligible patients were included in the individual patient data analyses.
Meta-analysis showed that dexamethasone did not reduce deaths or composite endpoints of death, neurologic sequelae, or hearing loss more than placebo (Table). In subgroup analyses, dexamethasone reduced death (13% vs 29%, P = 0.01) and the composite of death, severe neurologic sequelae, or severe hearing loss (30% vs 45%, P = 0.03) more than placebo in patients > 55 years of age. Dexamethasone and placebo did not differ in other age groups (< 5 y, 5 to 15 y, or 15 to 55 y), and there were no consistent treatment-by-age interactions.
Dexamethasone did not reduce deaths or neurologic sequelae more than placebo in bacterial meningitis.
Dexamethasone vs placebo in bacterial meningitis†
†NS = not significant; other abbreviations defined in Glossary. RRR, NNT, and CI calculated from data in article.
Zar FA. Dexamethasone did not reduce mortality or neurologic sequelae in bacterial meningitis. Ann Intern Med. ;153:JC2–10. doi: 10.7326/0003-4819-153-4-201008170-02010
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Published: Ann Intern Med. 2010;153(4):JC2-10.
CNS Infections, Infectious Disease, Neurology.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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