Meningitis: bacterial: no clear benefit from dexamethazone

Clinical bottom line (level 1b-)

Patients with severe bacterial meningitis who receive dexamethasone compared with placebo are not clearly more likely to recover without neurological sequelae.

Thomas et al: Intensive Care Medicine 1999; 25: 475-480

Expires November 2003

The study

Double-blinded concealed randomised trial without intention-to-treat
Setting: 21 emergency departments or intensive care units France

62 patients (aged mean 45, 57% male) with clinical signs of presumed primary bacterial meningitis (fever > 38 C, cloudy CSF or elevated white cell count with > 50% polymorphonuclear cells)

Excluded if

aged < 18, > 79

septic shock

acute post-surgical or post-traumatic meningitis

brain abscess

history of hypersensitivity to betalactam antibiotics or corticosteroids

organ transplant

treated with more than one dose of parenteral betalactam antibiotics or any other adequate treatment for more than 3 hours

first empiric therapy not a penicillin

Note:

Patients were stratified for centre before randomisation.

Control Group: (n = -, 29 analysed): placebo
Experimental Group: (n = -, 31 analysed): dexamethasone 10 mg iv once every 6 hours for 3 days
All patients received 150-300 mg/kg/day amoxicillin.
97% followed for 30 days

The evidence

Outcome	Time to outcome	CER	EER	RRR (95% CI)	ARR (95% CI)	NNT (95% CI)
not cured	30 days	14 (48.3%)	8 (25.8%)	47% (-8% to 74%)	22.5% (-1.36% to 46.3%)	4 (NNT = 2 to infinity; NNH = 73 to infinity)

Citation

Thomas R, Le Tulzo Y, Bouget J, et al: trial of dexamethasone treatment for severe bacterial meningitis in adults. Intensive Care Medicine 1999; 25: 475-480

Search Terms:
Contributor: Chris Ball and Clare Wotton, November 1999
Reviewer:

_{Clinical Question.}

_Patient	_{severe bacterial meningitis}
_{Intervention or Exposure}	_{dexamethasone}
_Comparison	_placebo
_Outcome	_{neurological sequelae}