Role of dexamethasone in acute bacterial meningitis in adults.
OBJECTIVE
To evaluate the role of dexamethasone as adjunctive therapy in adult acute bacterial meningitis (ABM) in two groups of patients treated with antibiotics alone or a combination of antibiotics and dexamethasone.


METHODS
Systematic sampling interventional open cohort study.


METHODS
Department of Medicine (Medical Unit II), Jinnah Postgraduate Medical Centre, Karachi.


METHODS
Sixty eight patients aged 12-85 years admitted in Medical Unit II and diagnosed to have ABM. Patients were divided into two groups. Group A received anti-microbial therapy for 14 days (a combination of benzyl penicillin 6 million units I/V 6 hourly and chloramphenicol 1 gm I/V 6 hourly) and group B received the same antimicrobial therapy with dexamethasone 0.6 mg/kg/day in 3 divided doses for 4 days.


METHODS
Differences in mortality and morbidity in the two groups and differences in the CSF inflammatory parameters between the two groups of patients.


RESULTS
There was early resolution of fever, headache and altered consciousness in group B as compared to group A. Cranial nerves involvement was lower in group B. There was no difference in the occurrence of other focal neurological deficits between the two groups. CSF inflammatory parameters (glucose, protein and WBC count) were significantly better in group B by day 5. No complications attributable to dexamethasone were seen in group B.


CONCLUSIONS
There was early resolution of symptoms and CSF inflammatory parameters in the group that received dexamethasone as adjuvant therapy. Mortality was lower in the group treated with dexamethasone but the difference was not statistically significant. Dexamethasone should be administered to all adults patients with ABM.
Ahsan
T
T
Medical Unit 2, Department of Medicine, Jinnah Postgraduate Medical Centre, Karachi.
Shahid
M
M
Mahmood
T
T
Jabeen
R
R
Jehangir
U
U
Saleem
M
M
Ahmed
N
N
Shaheer
A
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D003907:Dexamethasone / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D016920:Meningitis, Bacterial / Q000188:drug therapy*; D008875:Middle Aged
D000900:Anti-Bacterial Agents; D005938:Glucocorticoids; D003907:Dexamethasone