High-dose intravenous dexamethasone in the management of diarrheal patients with enteric fever and encephalopathy.
We conducted a retrospective chart analysis of diarrheal patients with enteric fever and encephalopathy (among survivors and non-survivors) to examine the role of high-dose, intravenous dexamethasone as an adjunct to appropriate antimicrobial therapy in their management. We studied all patients admitted to the Special Care Ward (SCW) of Dhaka Hospital between October 2006 and October 2007 with a diagnosis of encephalopathy in association with enteric fever. Twenty-three cases were identified with three mortalities. All bacterial isolates (Salmonella Typhi and Salmonella Paratyphi) were multi-drug resistant. Survivors were significantly more likely to have received high dose dexamethasone (100% vs 00%; p < 0.001) and had hypoglycemia less often (6% vs 67%; p = 0.045) compared to those who died. The results suggest high dose intravenous dexamethasone, as an adjunct to appropriate antimicrobial therapy, substantially reduces mortality among diarrheal patients presenting with enteric encephalopathy.
Clinical Sciences Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh. chisti@icddrb.org
Mohammod Jobayer
MJ
Chisti
Pradip Kumar
PK
Bardhan
Sayeeda
S
Huq
Wasif Ali
WA
Khan
Ali Miraj
AM
Khan
Sharifuzzaman
Mohammed Abdus
MA
Salam
D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001927:Brain Diseases / Q000188:drug therapy*; D003907:Dexamethasone / Q000008:administration & dosage / Q000627:therapeutic use*; D003967:Diarrhea / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D024901:Drug Resistance, Multiple, Bacterial; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000150:complications; D007275:Injections, Intravenous; D008297:Male; D012189:Retrospective Studies; D014435:Typhoid Fever / Q000150:complications / Q000188:drug therapy*
D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D003907:Dexamethasone