CHAPTER 41 STEROIDS IN ADULT MENINGITIS

Dexamethasone in adults with bacterial meningitis

de Gans J, van de Beek D, European Dexamethasone in Adulthood Bacterial Meningitis Study Investigators. N Engl J Med. 2002;347(20):1549–1556

BACKGROUND

Acute bacterial meningitis carries high morbidity and mortality, thought to be partly a result of inflammation in the CNS secondary to the bacteriolytic effect of appropriate antibiotic treatment. Previous small, nonrandomized studies in adults, children, and animal models suggested that adjuvant treatment with corticosteroids might benefit adults with bacterial meningitis by deceasing this inflammatory response; however, no randomized trial had been done.

OBJECTIVES

To evaluate whether adjunctive dexamethasone treatment improves outcomes in adult patients with bacterial meningitis.

METHODS

Multicenter, prospective, randomized, double-blind trial in the Netherlands between June 1993 and December 2001. Patients were randomized to dexamethasone or placebo. All patients were initially treated with amoxicillin with changes permitted at the discretion of the treating physician.

Participants

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