Dexamethasone in Vietnamese adolescents and adults with bacterial meningitis.
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] .).
Nguyen
Thi Hoang Mai
TH
Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.
Tran
Thi Hong Chau
TH
Thwaites
Guy
G
Ly
Van Chuong
VC
Dinh
Xuan Sinh
XS
Ho Dang
Trung Nghia
TN
Dang
Quoc Tuan
QT
Nguyen
Duy Phong
DP
Nguyen
Hoan Phu
HP
To
Song Diep
SD
Nguyen
van Vinh Chau
vV
Nguyen
Minh Duong
MD
Campbell
James
J
Schultsz
Constance
C
Parry
Chris
C
Torok
M Estee
ME
White
Nicholas
N
Nguyen
Tran Chinh
TC
Tran
Tinh Hien
TH
Stepniewska
Kasia
K
Farrar
Jeremy J
JJ
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
D000900:Anti-Bacterial Agents; D005938:Glucocorticoids; D002443:Ceftriaxone; D003907:Dexamethasone