Corticosteroid administration and outcome of adolescents and adults with acute bacterial meningitis: a meta-analysis.
OBJECTIVE
To systematically assess the effect of the adjunctive administration of corticosteroids in the treatment of acute bacterial meningitis.


METHODS
We performed a systematic review and meta-analysis by searching several databases for reports (published from January 1966 through February 2008) of placebo-controlled randomized trials of corticosteroid use in the treatment of adolescents and adults with acute bacterial meningitis. We used random-effects models. Sources of heterogeneity were explored by preplanned subgroup analyses.


RESULTS
The 4 eligible trials (published between 1999 and 2007) were of high methodological quality and included 1261 adult patients. Overall, the short-term mortality rate associated with corticosteroid administration was not significantly lower than that associated with placebo (relative risk [RR], 0.81; 95% confidence interval [CI], 0.54-1.20; I(2)=54%). A significant interaction was found between the effect of corticosteroids and the income status of the country (P=.02) and the prevalence of infection with human immunodeficiency virus (HIV) among study populations (P=.03). The administration of corticosteroids resulted in a lower short-term mortality rate than did the administration of placebo in high-income countries (pooled RR, 0.5; 95% CI, 0.27-0.92; I(2)=0%) and in the studies with a low prevalence of infection with HIV (RR, 0.66; 95% CI, 0.44-0.99; I(2)=0%). In studies from high-income countries, the number needed to treat with corticosteriods to prevent 1 death and 1 neurologic sequela was 12.5 (95% CI, 7.1-100.0) and 11.0 (95% CI, 5.6-100.0), respectively.


CONCLUSIONS
Our meta-analysis suggests that the adjunctive administration of corticosteroids is beneficial in the treatment of adolescents and adults with bacterial meningitis in patient populations similar to those seen in high-income countries and in areas with a low prevalence of HIV infection.
Department of Internal Medicine, Division of Infectious Diseases, Main Hospital, King Fahd Medical City, Riyadh, Saudi Arabia.
Abdullah M
AM
Assiri
Faisal A
FA
Alasmari
Valerie A
VA
Zimmerman
Larry M
LM
Baddour
Patricia J
PJ
Erwin
Imad M
IM
Tleyjeh
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D005938:Glucocorticoids / Q000627:therapeutic use*; D015658:HIV Infections / Q000453:epidemiology; D006801:Humans; D016920:Meningitis, Bacterial / Q000188:drug therapy* / Q000401:mortality; D015995:Prevalence; D016032:Randomized Controlled Trials as Topic
D005938:Glucocorticoids