title: Dexamethasone and long-term survival in bacterial meningitis.
abstract: BACKGROUND
  Data on the long-term effect of dexamethasone on survival in bacterial meningitis are lacking.
  
  
  METHODS
  A long-term follow-up study of the European Dexamethasone in Adulthood Bacterial Meningitis Study was performed. In this double-blind, randomized clinical trial, 301 patients were randomly assigned to receive adjunctive dexamethasone (n = 157) or placebo (n = 144) between June 1993 and December 2001. We obtained survival data of patients using the Dutch Municipal Population Register.
  
  
  RESULTS
  Death had occurred in 32 of 301 included patients (11%) at the primary outcome measurement 8 weeks after randomization. Follow-up was obtained for 228 of 246 evaluable patients (93%), with median follow-up of 13 years. Overall, 31 of 144 patients (22%) in the dexamethasone group died and 44 of 134 patients (33%) in the placebo group died (log-rank p = 0.029). After the primary end point of the study at 8 weeks, 20 patients in the dexamethasone group died and 23 patients in the placebo group died (log-rank p = 0.27), with age being the sole predictor of death (p < 0.001).
  
  
  CONCLUSIONS
  In adults with community-acquired bacterial meningitis, the survival benefit from adjunctive dexamethasone therapy is obtained in the acute phase of the disease and remains for years.
  
  
  METHODS
  This study of a population of Dutch patients shows Class III evidence that dexamethasone provides an extended survival benefit in patients treated for bacterial meningitis, and this survival benefit extends as long as 20 years.
authors.affiliation: Department of Neurology, Center of Infection and Immunity Amsterdam, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Daan
authors.initials: D
authors.lastname: Fritz
authors.forename: Matthijs C
authors.initials: MC
authors.lastname: Brouwer
authors.forename: Diederik
authors.initials: D
authors.lastname: van de Beek
mesh_terms: D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D017714:Community-Acquired Infections / Q000188:drug therapy* / Q000401:mortality* / Q000473:pathology; D003907:Dexamethasone / Q000008:administration & dosage*; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D016920:Meningitis, Bacterial / Q000188:drug therapy* / Q000401:mortality* / Q000473:pathology; D012042:Registries; D013995:Time
chemical_list: D000893:Anti-Inflammatory Agents; D003907:Dexamethasone