A Cochrane review [Abstract] 2 included 5 RCTs with a total of 1451 patients with bacterial meningitis. Four trials were conducted in children under 16 years, and one trial in adults and adolescents older than 14 years. The etiology of meningitis was not clear. One trial took place in Finland, one in South America, one in India and two in Malawi. All participants received broad-spectrum iv. antibiotic treatment. Four trials evaluated glycerol vs. placebo, and one glycerol vs. 50% dextrose; in addition 3 trials evaluated dexamethasone and one trial paracetamol in a factorial design. As dexamethasone appeared to have no modifying effect, the results were aggregated across arms where both treatment and control groups received corticosteroids and where both treatment and control groups did not. Compared to placebo, glycerol had little or no effect on death in people with bacterial meningitis (RR 1.08, 95% CI 0.90 to 1.30; 5 trials, n=1272); but may reduce neurological disability (RR 0.73, 95% CI 0.53 to 1.00; 5 studies, n=1270). Glycerol had little or no effect on seizures during treatment for meningitis (RR 1.08, 95% CI 0.90 to 1.30, 4 trials, n=1090). Glycerol reduced the risk of subsequent deafness (RR 0.64, 95% CI 0.44 to 0.93, 5 trials, n=922). Glycerol has little or no effect on gastrointestinal bleeding (RR 0.93, 95% CI 0.39 to 2.19; 3 studies, n=607). The evidence on nausea, vomiting and diarrhoea is uncertain (RR 1.09, 95% CI 0.81 to 1.47; 2 studies, n=851)
Comment: The quality of the evidence is downgraded by imprecise results (small trials and few events, it is probable that the trials included patients with Haemophilus influenzae meningitis) and indirectness (differences in studied patients, two trials conducted in a developing country).
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