Dexamethasone therapy for children with bacterial meningitis

Dexamethasone does not appear to be effective in preventing neurological complications or hearing impairment in children with bacterial meningitis. Dexamethasone is a corticosteroid that works as an anti-inflammatory. A total of 143 children between eight weeks and 12 years old with bacterial meningitis were treated and evaluated. All children received the antibiotic ceftriaxone. Sixty-nine of the children also received four days of treatment with 0.15 milligrams of dexamethasone per kilogram of weight every six hours. Neurological and hearing exams were performed within 24 hours of admission and again at six weeks and one year after discharge. Twenty-two children had moderate-to-severe hearing loss in both ears at the time of the first exam. There was no significant difference in the number of children with hearing impairment between the dexamethasone-treated and the antibiotic-only treated children. There was also no significant difference in neurologic complications between the two groups.
Objective. To determine whether treatment with dexamethasone and ceftriaxone for children with bacterial meningitis reduces the frequency of either sensorineural hearing loss or other neurologic sequelae. Design. This was a prospective, multicentered, placebo-controlled clinical trial. Subjects were followed for 1 year. Setting. The study was conducted in six children's hospitals located in Pittsburgh, Houston, Los Angeles, Chicago, Washington, D.C., and Columbus, Ohio. Patients. Enrolled were 173 children, 8 weeks to 12 years of age, with suspected bacterial meningitis; 143 children were evaluable. Eighty-seven percent of patients were followed for at least 6 weeks to 3 months, and 67% were followed for 1 year. Interventions. Subjects were randomized to receive ceftriaxone with or without dexamethasone (0.15 mg/kg every 6 hours for 4 days). Auditory brainstem responses (ABR) were measured within 24 hours of admission. Main outcome measures. Hearing, development, and neurologic sequelae were assessed at the time of discharge and 6 weeks and 1 year later. Main results. One hundred forty-three patients (69 received dexamethasone and 74 received placebo) with bacterial meningitis were evaluable: Haemophilus influenzae type b (83), Streptococcus pneumoniae (33), Neisseria meningitidis (24), and three others. Overall, there was no significant difference in auditory outcome between dexamethasone and placebo recipients. Twenty-two children had bilateral moderate or more severe hearing loss at the time of the first ABR. At follow-up, the resolution of hearing impairment was nearly identical for each group. Nine of ten children who remained persistently deaf were deaf at the time of the first ABR. There were no differences in neurologic or developmental outcome between groups. Conclusion. All but one child with persistent bilateral moderate or more severe hearing loss had demonstrable deafness at the time of the first ABR. Dexamethasone did not significantly improve audiologic, neurologic, or developmental outcome in children with bacterial meningitis. Pediatrics 1995;95:21-28; bacterial meningitis, steroids, dexamethasone, Haemophilus influenzae.