Meningitis: dexamethasone reduces hearing loss in children with H. influenzae b meningitis

Clinical bottom line (level 1a)

  1. Children with Haemophilus influenzae b meningitis who receive dexamethasone are less likely to develop hearing loss (NNT = 13 at unknown) .
  2. Children with Streptococcus pneumoniae meningitis who receive dexamethasone compared with nothing are not clearly less likely to have hearing loss.
  3. There is no clear effect on other neurological deficits.
McIntyre et al: Journal of the American Medical Association 1997; 278 (11): 925-931
Expires November 2003

The study

Systematic review of all randomised or quasi-randomised controlled trials of
  • Patients: children with bacterial meningitis
  • Intervention: dexamethasone
  • Outcome: neurological or hearing deficit


    • Articles found in English using Medline, Healthline, AIDSline, 1988 to 1996 (search terms: dexamethasone, meningitis ) and searching bibliographies of eligible articles and contacting authors of identified studies.

    Selection criteria: see above
    Appraisal criteria: using a predetermined protocol (not detailed)
    Articles excluded if:
    • studies performed before 1988 due to wide variation in antibiotic and steroid doses


    11 studies found
    A random-effects model was used

    The evidence

    Outcome Time to outcome CER OR
    (95% CI)    		 NNT
    (95% CI)
    hearing loss in H. influenzae b infection - unknown 27/233
    (11.6%)    		 0.31
    (0.14 to 0.69)     		13
    (10 to 30)
    hearing loss with Strep pneumoniae infection - unknown 17/97
    (17.5%)    		 0.52
    (0.17 to 1.46)     		13
    (NNT = 7 to infinity;
    NNH = 16 to infinity)
    other neurological deficits (any organism) - unknown 38/367
    (10.4%)    		 0.59
    (0.34 to 1.02)     		25
    (NNT = 15 to infinity;
    NNH = 540 to infinity)

    • Patients given more than 2 days of dexamethasone were not clearly more likely to have better outcome than patients given only 2 days of steroids.

    Comments

    1. Currently extinct from developed countries, Haemophilus influenzae b meningitis remains a significant cause of mortality and morbidity in developing countries. The lack of immunization in these countries, attributed to vaccine "prohibitive cost" and to priority "issues" should not be accepted in the third millennium!

    Citation

    1. McIntyre PB, Berkey CS, King SM, et al: dexamethasone as adjunctive therapy in bacterial meningitis: a meta-analysis of randomized clinical trials since 1988. Journal of the American Medical Association 1997; 278 (11): 925-931
    Search Terms:
    Contributor: Chris Ball and Clare Wotton, November 1999
    Reviewer: Mona Nabulsi

    Clinical Question.
    Patient children with bacterial meningitis
    Intervention or Exposure dexamethasone
    Comparison placebo
    Outcome hearing loss neurological deficit