CHAPTER 42 STEROIDS IN PEDIATRIC MENINGITIS

The Beneficial Effects of Early Dexamethasone Administration in Infants and Children with Bacterial Meningitis

Odio CM, Faingezicht I, Paris M, et al. N Engl J Med. 1991;324(22):1525–1531

BACKGROUND

Bacterial meningitis is a life-threatening illness with high neurologic morbidity. Animal models showed an increase in inflammatory markers after administration of antibiotics that was coincident with increases in cell wall products from the destroyed bacteria. This immune response was thought to worsen outcomes and some prior studies had demonstrated potential benefit with dexamethasone use in adult patients if given prior to administration of antibiotics. At the time of this study no experimental study had been conducted in children.

OBJECTIVES

To determine the clinical effect of dexamethasone in children with bacterial meningitis.

METHODS

Randomized, placebo-controlled, double-blinded study conducted in a single center in Costa Rica.

Patients

One hundred and one infants and children age 6 weeks to 13 years diagnosed with bacterial meningitis. Approximately 80% were younger than 2 years and 90% younger than 5 years.

Intervention Evaluated

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