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W. Raven 15-01-13

Dexamethason and long-term survival in bacterial meningitis Fritz et al, Neurology , November 2012. W. Raven 15-01-13. Achtergrond . Bacteriele meningitis spoedeisende aandoening Dexa vooraf antibiotica In acute fase zinvol

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W. Raven 15-01-13

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  1. Dexamethason and long-term survival in bacterial meningitisFritz et al, Neurology, November 2012 W. Raven 15-01-13

  2. Achtergrond • Bacteriele meningitis spoedeisende aandoening • Dexa vooraf antibiotica • In acute fase zinvol • Behandeling van meningitis met AB + dexa niet bewezen zinvol op lange termijn

  3. Wat? • Double blind , randomized clinical trial in NL. • Primairy outcome: GCS op 8 wkn. • Long term follow up (median 13 jaar)

  4. Wie&Hoe • 301 volwassenen met bacteriële meningitis • Groep 1: dexamethason 10 mg iv 15 min vooraf aan AB. • Groep 2: pacebo 15 min vooraf aan AB

  5. Results • 8 wkn (1993): • 11 van 157 ( 7%) dood in dexa groep • 21 van 144 (15%) dood in placebo groep • p = 0.04 • 2011 • 31 van 144 (22%) dood in dexa groep • 44 van 134 (33%) dood in placebo groep • p = 0.028

  6. Overleving

  7. Conclusie • Zowel korte- als lange termijn voordeel • Overleving wordt behouden op langere termijn.

  8. Discussie • Alleen bewezen studies in westerse landen • Wegens? • Stollingsmodulerende eigenschappen dexa • Hyperglycemisch bij dexa • In ontwikkelingslanden mogelijk hierop minder goede controle door arbeidsintensieve logistiek.

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