What is the role of corticosteroids in the treatment of Haemophilus influenzae type b (Hib) meningitis?

Updated: Jul 09, 2018
  • Author: Prateek Lohia, MD, MHA; Chief Editor: Niranjan N Singh, MBBS, MD, DM, FAHS, FAANEM  more...
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Answer

Experimental and pathological evidence strongly suggests that host immune responses to the cell wall constituents of lysed bacteria or other epitopes play roles in the pathogenesis of bacterial meningitis. Further, experimental investigations have produced support for the concept that corticosteroids may significantly reduce the prevalence of neurologic sequelae in individuals with meningitis.

Most clinical studies, including a meta-analysis, show that early use of dexamethasone improves outcomes of treatment, chiefly in preventing hearing loss. Two recent studies have been controversial. One was retrospective and the children in the steroid arm were sicker and more likely to be ventilated. The other study, a prospective study from Malawi, had a high percentage of children with HIV infection and most children seemed to present with severe illness and with a long delay before therapy. These studies emphasize 2 important points: (1) early administration of steroids (prior to or with the first dose of antibiotics) is beneficial and (2) the use of steroids after the development of severe neurological damage may be of limited benefit.

The Infectious Diseases Society of America considers the use of dexamethasone in the treatment of HiB meningitis in infants and children to be an A-I recommendation. [24]  European guidelines recommend a total duration of 4 days for Hib meningitis in children whereas American guidelines recommend the use of dexamethasone for 2–4 days in children with Hib meningitis. [25, 26]

The recommended dose is 0.15 mg/kg every 6 hours for the first 2 days after initial diagnosis and treatment. Administering the dexamethasone either before or concomitant with the first dose of antimicrobial therapy is likely of considerable importance if a positive effect is expected.

No evidence indicates that this form of treatment with dexamethasone, administered during the first 2 days of illness, compromises the outcome of appropriate antimicrobial therapy. This may be especially true if such treatment is continued for only 2 days, although data to confirm this point of view are not currently available.

If dexamethasone treatment is elected, care must be exerted to avoid complications such as gastrointestinal hemorrhage.


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