Corticosteroids as adjunctive therapy in bacterial meningitis. A meta-analysis of clinical trials
P. L. Havens, K. J. Wendelberger, G. M. Hoffman, M. B. Lee and M. J. Chusid
Department of Pediatrics, Medical College of Wisconsin, Milwaukee.
A meta-analysis of all nine available controlled trials of corticosteroids
for adjunctive therapy for bacterial meningitis was performed. Risks of
various outcomes were assessed for control and treatment groups from each
study, and risk differences were determined. For each outcome a weighted
average of the individual risk differences was calculated. The results show
that corticosteroid administration did not reduce the risk of death or
neurologic abnormality at hospital discharge or follow-up examination.
Based on statistically combined results of the three most recent trials,
there is evidence that dexamethasone reduces the risk of bilateral moderate
or more severe hearing loss (risk difference, -9%; 95% confidence limits,
-15% and -3%). However, this may be true only for children with meningitis
caused by Haemophilus influenzae type b. There are inadequate data in
adults or in children with meningitis due to other organisms to demonstrate
the benefit of dexamethasone administration. Further study is necessary to
fully assess the benefits and risks of corticosteroids for adjunctive
therapy for bacterial meningitis.
