[Value of dexamethasone in purulent meningitis in children. Apropos of a comparative study of 85 children].
BACKGROUND
The beneficial effect of dexamethasone plus antibiotic therapy in bacterial meningitis is still controversial.


METHODS
Eighty-five children, aged 1 month to 14 years, were admitted between 1987 and 1990 for bacterial meningitis. They received the same antibiotic therapy for 10 days (7 days in meningococcal meningitis). The 44 children admitted since March 1989 were also given dexamethasone (0.15 mg/kg/6 hours for 4 days); the first injection was given before antibiotic therapy. Clinical (fever, neurological findings, audition) and laboratory data [CSF proteins, glucose, lactate, cell and bacterial counts; blood C-reactive protein (CRP), hemoglobin, leukocytes and platelets] were analyzed statistically.


RESULTS
The group treated with antibiotics plus dexamethasone showed decreases significantly greater in CSF protein and lactate levels after 48 hours than the children given antibiotics alone and an early (6 hours after the start of treatment) increase in CSF glucose. The blood CRP level of the dexamethasone plus antibiotics group decreased significantly within 48 hours. The numbers of neurological sequelae and deaths in this group were clearly lower than for the antibiotic group, but the risk of deafness did not appear to be altered.


CONCLUSIONS
These results confirm the beneficial effect of dexamethasone reported earlier. The relatively frequent transient recurrences of fever and increased CRP when dexamethasone was interrupted suggest that the dose and/or duration of dexamethasone treatment should be modified.
Marguet
C
C
Service de Pédiatrie, Centre Hospitalo-Universitaire, Hôpital Charles-Nicolle, Rouen.
Mallet
E
E
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003907:Dexamethasone / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D016920:Meningitis, Bacterial / Q000097:blood / Q000134:cerebrospinal fluid / Q000188:drug therapy* / Q000453:epidemiology; D012189:Retrospective Studies
D003907:Dexamethasone
Intérêt de la dexaméthasone au cours des méningites purulentes de l'enfant. A propos d'une étude comparative chez 85 enfants.