title: Dexamethasone in Vietnamese adolescents and adults with bacterial meningitis.
abstract: BACKGROUND
  It is uncertain whether all adults with bacterial meningitis benefit from treatment with adjunctive dexamethasone.
  
  
  METHODS
  We conducted a randomized, double-blind, placebo-controlled trial of dexamethasone in 435 patients over the age of 14 years who had suspected bacterial meningitis. The goal was to determine whether dexamethasone reduced the risk of death at 1 month and the risk of death or disability at 6 months.
  
  
  RESULTS
  A total of 217 patients were assigned to the dexamethasone group, and 218 to the placebo group. Bacterial meningitis was confirmed in 300 patients (69.0%), probable meningitis was diagnosed in 123 patients (28.3%), and an alternative diagnosis was made in 12 patients (2.8%). An intention-to-treat analysis of all the patients showed that dexamethasone was not associated with a significant reduction in the risk of death at 1 month (relative risk, 0.79; 95% confidence interval [CI], 0.45 to 1.39) or the risk of death or disability at 6 months (odds ratio, 0.74; 95% CI, 0.47 to 1.17). In patients with confirmed bacterial meningitis, however, there was a significant reduction in the risk of death at 1 month (relative risk, 0.43; 95% CI, 0.20 to 0.94) and in the risk of death or disability at 6 months (odds ratio, 0.56; 95% CI, 0.32 to 0.98). These effects were not found in patients with probable bacterial meningitis. Results of multivariate analysis indicated that dexamethasone treatment for patients with probable bacterial meningitis was significantly associated with an increased risk of death at 1 month, an observation that may be explained by cases of tuberculous meningitis in the treatment group.
  
  
  CONCLUSIONS
  Dexamethasone does not improve the outcome in all adolescents and adults with suspected bacterial meningitis; a beneficial effect appears to be confined to patients with microbiologically proven disease, including those who have received prior treatment with antibiotics. (Current Controlled Trials number, ISRCTN42986828 [controlled-trials.com] .).
authors: Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.
authors: Thi Hoang Mai
authors: TH
authors: Nguyen
authors: Thi Hong Chau
authors: TH
authors: Tran
authors: Guy
authors: G
authors: Thwaites
authors: Van Chuong
authors: VC
authors: Ly
authors: Xuan Sinh
authors: XS
authors: Dinh
authors: Trung Nghia
authors: TN
authors: Ho Dang
authors: Quoc Tuan
authors: QT
authors: Dang
authors: Duy Phong
authors: DP
authors: Nguyen
authors: Hoan Phu
authors: HP
authors: Nguyen
authors: Song Diep
authors: SD
authors: To
authors: van Vinh Chau
authors: vV
authors: Nguyen
authors: Minh Duong
authors: MD
authors: Nguyen
authors: James
authors: J
authors: Campbell
authors: Constance
authors: C
authors: Schultsz
authors: Chris
authors: C
authors: Parry
authors: M Estee
authors: ME
authors: Torok
authors: Nicholas
authors: N
authors: White
authors: Tran Chinh
authors: TC
authors: Nguyen
authors: Tinh Hien
authors: TH
authors: Tran
authors: Kasia
authors: K
authors: Stepniewska
authors: Jeremy J
authors: JJ
authors: Farrar
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002443:Ceftriaxone / Q000627:therapeutic use; D002555:Cerebrospinal Fluid / Q000382:microbiology; D003907:Dexamethasone / Q000009:adverse effects / Q000627:therapeutic use*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D016920:Meningitis, Bacterial / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D008875:Middle Aged; D015999:Multivariate Analysis; D017211:Treatment Failure; D014744:Vietnam
chemical_list: D000900:Anti-Bacterial Agents; D005938:Glucocorticoids; D002443:Ceftriaxone; D003907:Dexamethasone