Dexamethasone treatment in childhood bacterial meningitis in Malawi: a randomised controlled trial.
BACKGROUND
Steroids are used as adjuvant treatment in childhood pyogenic meningitis to attenuate host inflammatory responses to bacterial invasion. We aimed to assess the effectiveness of dexamethasone in management of acute bacterial meningitis in a developing country.


METHODS
In a double-blind, placebo controlled trial, we included 598 children with pyogenic meningitis who had been admitted to the children's wards of the Queen Elizabeth Central Hospital, Blantyre, Malawi. We did physical, neurological, developmental, and hearing assessments at 1 and 6 months after discharge. The primary outcome was overall death. Secondary outcomes included sequelae, in-hospital deaths, and death after discharge. Analysis was done by intention to treat.


RESULTS
Of the 598 included children, 307 (51%) were assigned to dexamethasone and 295 (49%) to placebo. 338 (40%) of 598 patients had Streptococcus pneumoniae, 170 (28%) Haemophilus influenzae type b, 66 (11%) Neisseria meningitidis, and 29 (5%) Salmonella spp. 78 (13%) patients had no growth on culture. The number of overall deaths was the same in the two treatment groups (relative risk 1.00 [95% CI 0.8-1.25], p=0.93). At final outcome, sequelae were identified in 84 (28%) of children on steroids and in 81 (28%) on placebo (relative risk 0.99 [95% CI 0.78-1.27], p=0.97). The number of children dying in hospital did not differ between groups.


CONCLUSIONS
Steroids are not an effective adjuvant treatment in children with acute bacterial meningitis in developing countries.
Paediatric Department, College of Medicine, Blantyre, Malawi. emolyneux@malawi.net
E M
EM
Molyneux
A L
AL
Walsh
H
H
Forsyth
M
M
Tembo
J
J
Mwenechanya
K
K
Kayira
L
L
Bwanaisa
A
A
Njobvu
S
S
Rogerson
G
G
Malenga
D000293:Adolescent; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003907:Dexamethasone / Q000627:therapeutic use*; D004311:Double-Blind Method; D004351:Drug Resistance; D005260:Female; D006801:Humans; D007223:Infant; D008295:Malawi / Q000453:epidemiology; D008297:Male; D016920:Meningitis, Bacterial / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality; D016019:Survival Analysis; D017211:Treatment Failure
D000893:Anti-Inflammatory Agents; D003907:Dexamethasone