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Adjunctive Dexamethasone Treatment in Bacterial Meningitis: Clinical Efficacy and Recommendations

Explore the efficacy of dexamethasone as an adjunct therapy in bacterial meningitis based on double-blind studies, age-specific responsiveness, and subgroup analysis. Learn recommended dosages and guidelines for optimal outcomes.

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Adjunctive Dexamethasone Treatment in Bacterial Meningitis: Clinical Efficacy and Recommendations

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  1. Adjunctive Dexamethasone Treatment in Patients with Bacterial Meningitis David Malmud, M.D.

  2. Dexamethasone in Meningitis • Antibiotics cause bacterial cell lysis which stimulates inflammatory mediator production in CSF. • Steroids thought to blunt this response if given with antibiotics.

  3. Lebel MH, et al. Dexamethasone Therapy for Bacterial Meningitis: Results of Two Double-Blind, Placebo Controlled Trials. NEJM 1988;319:964-71. • Prospective, randomized, placebo controlled, double blind study. • Children ages 2 months to 15 years • All patients received 3rd generation cephalosporin. • 102 patients received dexamethasone 0.15mg/kg IV q6h. 98 patients received placebo. • 77% of cases were H. influenzae

  4. Lebel MH, et al. Dexamethasone Therapy for Bacterial Meningitis: Results of Two Double-Blind, Placebo Controlled Trials. NEJM 1988;319:964-71.

  5. Girrgis NI, et al. Dexamethasone Treatment for Bacterial Meningitis in Children and Adults. Pediatr Infect Dis J 1989;8:848-51. • Prospective, randomized, placebo controlled, unblinded study. • Children and adults. • Only found improvement in pneumococcus subgroup. • 60% of patients were initially comatose. • Most patients received prior inadequate therapy.

  6. Girrgis NI, et al. Dexamethasone Treatment for Bacterial Meningitis in Children and Adults. Pediatr Infect Dis J 1989;8:848-51.

  7. de Gans J and van de Beek D. Dexamethasone in Adults with Bacterial Meningitis. NEJM 2002;347:1549-56. • Multicenter, prospective, randomized, placebo controlled, double blind study. • All patients adults >17 years. • Most patients received amoxicillin. • 157 patients received dexamethasone 10mg IV q6h for 4 days. 144 patients received placebo. • Most benefits seen can be attributed to subgroup infected with pneumococcus, but no harm for other subgroups.

  8. de Gans J and van de Beek D. Dexamethasone in Adults with Bacterial Meningitis. NEJM 2002;347:1549-56.

  9. Recommendations • Give Dexamethasone 10mg IV before or with antibiotics. • If using vancomycin, use high doses (2-3g/day). • Avoid dexamethasone if patient has already received antibiotics. • Dexamethasone has shown no benefit in patients with N. meningitidis on Gram’s stain.

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