What are the benefits of steroid therapy for bacterial meningitis?

Updated: Jul 16, 2019
  • Author: Rodrigo Hasbun, MD, MPH; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

In a meta-analysis by Brouwer et al, corticosteroids significantly reduced hearing loss and neurologic sequelae but did not reduce overall mortality. However, there was a trend toward lower mortality in adults receiving corticosteroids, and subgroup analyses showed that corticosteroids reduced severe hearing loss in H influenzae meningitis and reduced mortality in S pneumoniae meningitis. However, the investigators found no beneficial effect for patients in low-income countries. [38]

On the other hand, a meta-analysis of individual patient data by van de Beek et al was unable to identify which patients were most likely to benefit from dexamethasone treatment; indeed, no significant reduction in death or neurologic disability was found in any subgroups, including those determined by specific causative organisms, predexamethasone antibiotic treatment, HIV status, or age. The researchers concluded that the benefits of adjunctive dexamethasone in bacterial meningitis remain unproven. [39]

In developing countries, the use of oral glycerol (rather than dexamethasone) has been studied as adjunctive therapy in the treatment of bacterial meningitis in children. In limited studies, it appears to reduce the incidence of neurologic sequelae while causing few side effects. [40]


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