The Pharmaceutical Journal
Vol 280 No 7501 p559
10 May 2008

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Corticosteroids do not improve infant survival in bacterial meningitis

Using adjuvant corticosteroids to treat bacterial meningitis does not reduce the risk of infected children dying, a study published this week in JAMA shows (2008;299:2048).

The researchers say that the use of corticosteroids in addition to primary therapy for bacterial meningitis reduces mortality in adults. However, in children, studies reveal conflicting results and the potential benefit of adjuvant corticosteroids remains unclear.

In a multicentre, observational study, Jillian Mongelluzzo, of the Children’s Hospital of Philadelphia, and colleagues analysed data for 2,780 children, with a mean age of 3.4 years, discharged from hospital with bacterial meningitis. Streptococcus pneumoniae was the most commonly identified cause.

Adjuvant corticosteroids (most commonly dexamethasone) were administered to 248 of the children (8.9 per cent). The overall mortality rate was found to be 4.2 per cent (95 per cent confidence interval, 3.5–5 per cent); cumulative mortality rates were 2.2 per cent and 3.1 per cent at seven days and 28 days, respectively, after admission.

There were 15 deaths (6.0 per cent) in children who received corticosteroids and 102 deaths (4.0 per cent) in children who did not receive corticosteroids (relative risk 1.50; CI 0.89–2.54).

The researchers conclude that use of adjuvant corticosteroids was not associated with survival, length of hospital stay or infecting organism in children regardless of age. They say that the results may differ from those of adult studies for several reasons.

“First, adults may have different predisposing factors for meningitis or a different inflammatory response, either of which may alter the course of disease compared with children,” they say.

Secondly, the case fatality rate in pneumococcal meningitis in children is lower compared with that in adults (4.2 per cent vs 34 per cent, respectively) — the current study could have been underpowered to determine a difference in mortality, they add.

The researchers say that adjuvant corticosteroid use in bacterial meningitis appears to be increasing and may improve the long-term quality of life in some children.

However, a randomised trial is warranted before such corticosteroid use becomes routine.