Use of dexamethasone is suggested for adults with acute bacterial meningitis in high-income countries.
A Cochrane review [Abstract] 1 included 25 studies with a total of 4121 patients. Participants over 16 years were included in 7 studies (n=1517); in two studies, participants older than 12 years were considered adults. Dexamethasone was used in all studies; dosages ranged from 16 mg to 40 mg daily for 3 to 4 days. Study medication was administered before or with the antibiotics. When assessed the trials with adults, corticosteroids were associated with a non-significant reduction in mortality: 187 of 756 (24.7%) died in the corticosteroid-treated group vs. 215 of 761 (28.3%) in the control group (RR 0.74, 95% CI 0.53 to 1.05, p=0.09; 7 trials, n=1517). The rate of hearing loss in adults was lower in corticosteroid-treated participants as compared to controls: 68 of 433 (15.7%) vs. 90 of 411 (21.9%) (RR 0.74, 95% CI 0.56 to 0.98; 4 trials, n=844). There was a trend towards reduction in short-term neurologic sequelae in the corticosteroid-treated group (RR 0.72, 95% CI 0.51 to 1.01; 4 trials, n=542). In high income countries the effect on mortality was not significant (RR 0.76, 95% CI 0.82-1.10; 4 trials, n=881) but for hearing loss, there was a significant effect (RR 0.67, 95% CI 0.45-0.99; 3 trials, n=649).
Comment: The quality of evidence is downgraded by inconsistency (variability in results across studies).
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