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. 2010;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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