title: Adjunctive steroid treatment in acute bacterial meningitis. "To do or not to do: that is the question".
abstract: In experimental bacterial meningitis, adjunctive steroid treatment reduces the inflammatory response in the cerebrospinal fluid and subarachnoidal space, thereby improving neurological outcome. The clinical application of this concept was sustained by the European Dexamethasone Study which showed a beneficial effect of dexamethasone on neurological outcome and mortality in adult patients with bacterial--in particular S. pneumoniae-- meningitis. A thorough analysis of the data of this landmark trial as well as results from more recent trials in children and adults with bacterial meningitis worldwide do not support the use of adjunctive dexamethasone in meningitis. Moreover, dexamethasone may have detrimental effects with regard to antibiotic efficacy and late severe neurological complications. Until further data about steroid use in bacterial meningitis becomes available, we propose that dexamethasone therapy in this setting should be abandoned.
authors.affiliation: Department of l'Intensive Care, University Hospital, Vrije Universiteit Brussels, Belgium. Herbert.Spapen@uzbrussel.be
authors.forename: H
authors.initials: H
authors.lastname: Spapen
authors.forename: G
authors.initials: G
authors.lastname: Van Berlaer
authors.forename: M
authors.initials: M
authors.lastname: Moens
authors.forename: I
authors.initials: I
authors.lastname: Hubloue
mesh_terms: D000208:Acute Disease; D000075202:Contraindications; D003907:Dexamethasone / Q000009:adverse effects / Q000627:therapeutic use*; D004358:Drug Therapy; D005938:Glucocorticoids / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D016920:Meningitis, Bacterial / Q000188:drug therapy* / Q000401:mortality; D016032:Randomized Controlled Trials as Topic; D017211:Treatment Failure
chemical_list: D005938:Glucocorticoids; D003907:Dexamethasone