[Role of corticoids in purulent meningitis in children: analysis of literature studies].
Steroid therapy, in combination with antibiotics for bacterial meningitis in paediatric patients remains controversial. Steroids, and primarily dexamethasone a very potent anti-inflammatory agent, regulate the liberation of various cytokines and inflammatory mediators such as prostaglandins, released during bacterial meningitis and leading to long term complications. Several clinical trials studying infants and children with bacterial meningitis due to Haemophilus influenzae have evaluated the beneficial effects of the administration of dexamethasone at the onset of antibiotherapy and demonstrated that dexamethasone reduced the risk of acquired sensorineural deafness (bilateral moderate or more severe hearing loss) and the incidence of neurological sequelae. Limited information is available for the other bacterial meningitis, although meningococcal meningitis will become more frequent with the use of effective anti-Haemophilus vaccines. In addition some Streptococcus pneumoniae are now resistant to third generation cephalosporins and the use of dexamethasone in that case may be at risk. Finally, no evidence is available for an effective role for dexamethasone in neonatal bacterial meningitis, although it is quite often administered in that age group.
Jacqz-Aigrain
E
E
Unité de pharmacologie clinique, hôpital Robert-Debré, Paris, France.
Guillonneau
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M
D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D002648:Child; D003907:Dexamethasone / Q000627:therapeutic use*; D005938:Glucocorticoids / Q000627:therapeutic use*; D006312:Hearing Loss, Bilateral / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D016920:Meningitis, Bacterial / Q000150:complications / Q000188:drug therapy*; D013492:Suppuration
D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D003907:Dexamethasone
Place des corticoïdes dans les méningites purulentes de l'enfant: analyse des études de la littérature.