The Pharmaceutical Journal
Vol 269 No 7225 p732
23 November 2002

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New England Journal of Medicine: abstract (more)

Start steroids early in meningitis

Early treatment with dexamethasone improves outcome in patients with acute bacterial meningitis, a new study shows.

Researchers randomly assigned adult patients with acute bacterial meningitis to receive either dexamethasone 10mg (n=157) or placebo (n=144), taken 15 to 20 minutes before or with the first dose of antibiotic and then every six hours for four days.

Adjuvant treatment with dexamethasone reduced the risk of an unfavourable outcome (death, a vegetative state or moderate or severe disability) by 10 per cent (absolute risk reduction) compared with placebo (15 per cent versus 25 per cent). The proportion of patients who died was 7 per cent in the dexamethasone group and 15 per cent in the placebo group. Although dexamethasone was found to be of benefit in those with pneumococcal meningitis it did not provide a significant benefit in those with meningitis due to Neisseria meningitidis. Of the 108 patients with pneumococcal meningitis, 26 per cent in the dexamethasone group had an unfavourable outcome compared with 52 per cent in the placebo group. However, the researchers recommend that a four-day regimen of dexamethasone 10mg given every six hours, starting before or with the first dose of antibiotics, should be given to all patients with acute bacterial meningitis.

The study is published in The New England Journal of Medicine (2002;347:1549).