Dexamethasone efficacy on bacterial meningitis--a retrospective analysis of Albanian adult patients.
BACKGROUND
Research on the effects of corticosteroids in bacterial meningitis (BM) yielded conflicting results. While some studies reveal that corticosteroids improve the outcomes in BM treatments, others provide strong evidence that patients do not profit from this treatment. We investigated the factors that may impact the dexamethasone efficacy in patients with BM.


METHODS
In this retrospective study, we analyzed the medical records of patients with probable acute bacterial meningitis hospitalized between 2002 and 2008 at the Infectious Diseases Department, University Hospital Centre "Mother Theresa" of Tirana, Albania. They were all treated with dexamethasone. For study purposes, patients were divided into two subgroups: 1) Severely ill patients (Glasgow Coma Scale [GCS] <or= 7 and 2) Less severely ill patients (GCS 8-12). Patients were considered recovered when they reached a GCS >or= 13.


RESULTS
Sixty-seven patients analyzed had a mean age of 43.8 +/- 17.0 years old, forty-five (67.2%) of whom were males. The mean recovery time (RT) was 3.5 +/- 1.3 days, and four (6%) died. In the severely ill subgroup (GCS <or= 7 points), the Pearson correlation between the dexamethasone daily dose and the RT was -0.579, p < 0.01 level (2-tailed). There was no correlation found in the less severely ill group of patients (GCS 8-12 points).


CONCLUSIONS
This study suggests that the patients with lower GCS scores were significantly more likely to benefit from dexamethasone therapy. In this subgroup, high doses of corticosteroids can significantly reduce BM recovery time; however, patients with a high GCS do not benefit from dexamethasone therapy.
Ndreu
Arben H
AH
Service of Infectious Diseases, University Hospital Center Mother Theresa, Tirana, Albania.
Shytaj
Kastriot M
KM
Pilaca
Arben S
AS
Harxhi
Arjan K
AK
Kraja
Dhimiter V
DV
Petrela
Elizana Y
EY
Bara
Petrit Y
PY
Mingomataj
Ervin C
EC
D000293:Adolescent; D000328:Adult; D000368:Aged; D000415:Albania; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D003907:Dexamethasone / Q000627:therapeutic use*; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D016920:Meningitis, Bacterial / Q000188:drug therapy*; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult
D000893:Anti-Inflammatory Agents; D003907:Dexamethasone