L-641. Adjunctive Dexamethasone Therapy for Bacterial Meningitis in Adults: A Meta-Analysis of Randomized Controlled Trials
Session: Poster Session: New Issues With Central Nervous System Infections
Saturday, October 25, 2008: 12:00 AM
Room: Hall C
Background: Acute bacterial meningitis is associated with considerable morbidity and mortality. Adjunctive therapies have been advocated in order to reduce the burden of the disease. Methods: Two reviewers independently extracted data from published randomized controlled trials (RCTs) comparing corticosteroids with placebo or no treatment in patients with bacterial meningitis. A meta-analysis was performed. Results: Treatment with dexamethasone was associated with a non-significant lower mortality than placebo or no treatment (OR= 0.81, 95% CI 0.62-1.04). Dexamethasone was associated with significantly lower mortality in specific subgroups of patients: definite meningitis (0.55, 0.31-0.96), early presentation to hospital after the beginning of symptoms (0.61, 0.38-1.00), S. pneumoniae meningitis (0.26, 0.08-0.78), patients in countries with high (0.45, 0.23-0.87) and medium Human Development Index (0.65, 0.42-1.00). No benefit was seen with dexamethasone treatment in patients with probable meningitis (1.08, 0.57-2.02),N. meningitis meningitis (0.90, 0.30-2.72) and late presentation to hospital after the beginning of symptoms (0.80, 0.47-1.36).Dexamethasone was not associated with lower mortality regardless the prior use of antibiotics (0.81, 0.56-1.16) or not (0.85, 0.59-1.22). Dexamethasone was not associated with fewer unfavorable outcomes (0.85, 95% CI 0.65-1.13), but it was associated with fewer episodes of hearing impairment in high quality RCTs (0.64, 0.43-0.94). Conclusions: The currently available evidence suggests that dexamethasone should be administered to all adult patients with bacterial meningitis. However, additional large studies are needed to clarify the role of the duration of symptoms, disease severity, and antibiotic administration before the initiation of treatment with dexamethasone on modifying the outcomes.
Dimitrios Matthaiou, MD1, Konstantinos Vardakas, MD1, Matthew Falagas, MD, MSc, DSc1 and  M. E. Falagas, None., (1)Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece