Template:Steroids Bacterial Meningitis: Difference between revisions

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*The goal of early glucocorticoids for bacterial meningitis, is to reduce the neurologic morbidity, particularly with [[Streptococcus pneumoniae]]
*The goal of early glucocorticoids for bacterial meningitis, is to reduce the neurologic morbidity, particularly with [[Streptococcus pneumoniae]]
*Early animal research demonstrated a decrease in hearing loss in rabbits<ref>Bhatt SM et al. Progression of hearing loss in experimental pneumococcal meningitis: correlation with cerebrospinal fluid cytochemistry. J Infect Dis. 1993;167(3):675</ref> and shown in adults in Europe to reduce mortality in patient with [[Streptococcus pneumoniae]] [[Meningitis]]<ref>[[EBQ:De Gans - Steroids for Bacterial Meningitis]]</ref>
*Early animal research demonstrated a decrease in hearing loss in rabbits<ref>Bhatt SM et al. Progression of hearing loss in experimental pneumococcal meningitis: correlation with cerebrospinal fluid cytochemistry. J Infect Dis. 1993;167(3):675</ref> and shown in adults in Europe to reduce mortality in patient with [[Streptococcus pneumoniae]] [[Meningitis]]<ref>[[EBQ:De Gans - Steroids for Bacterial Meningitis]]</ref>
*However meta-analysis  demonstrated no mortality difference overall and '''only''' in the subgroup with cultures positive for [[Streptococcus pneumoniae]] and not those for [H. Influenza]] or [[Neisseria meningitidis]]<ref>Brouwer MC, McIntyre P, de Gans J, Prasad K, van de Beek D. Corticosteroids for Acute Bacterial Meningitis. Cochrane Database of Systematic Reviews 2010, Issue 9.</ref>
*However meta-analysis  demonstrated no mortality difference overall and '''only''' in the subgroup with cultures positive for [[Streptococcus pneumoniae]] and not those for [[Haemophilus influenzae]] or [[Neisseria meningitidis]]<ref>Brouwer MC, McIntyre P, de Gans J, Prasad K, van de Beek D. Corticosteroids for Acute Bacterial Meningitis. Cochrane Database of Systematic Reviews 2010, Issue 9.</ref>
*Dexamethasone has been shown to decrease blood-brain permeability and therefore antibiotic penetration into subarachnoid space specifically with [[Vancomycin]]<ref>Ricard JD et al. Levels of vancomycin in cerebrospinal fluid of adult patients receiving adjunctive corticosteroids to treat pneumococcal meningitis: a prospective multicenter observational study. Clin Infect Dis. 2007;44(2):250</ref>  However increasing the serum concentration of [[Vancomycin]] may increase the CSF levels and can possibly counteract the effects from dexamethasone
*The Infectious Disease Society of America recommends the use of dexamethasone in all patients with suspected Strep. Pneumoniae meningitis. <ref>Tunkel AR et al. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis. 2004;39(9):1267</ref> and continuation of the dexamethasone as an in-patient can be continued based on the culture and gram stain results of the CSF
**Suspicion for pneumococcal meningitis can be based on the inclusion criteria from the [[EBQ:De_Gans_-_Steroids_for_Bacterial_Meningitis|De Gans Study]]

Latest revision as of 22:28, 5 November 2014

  • The goal of early glucocorticoids for bacterial meningitis, is to reduce the neurologic morbidity, particularly with Streptococcus pneumoniae
  • Early animal research demonstrated a decrease in hearing loss in rabbits[1] and shown in adults in Europe to reduce mortality in patient with Streptococcus pneumoniae Meningitis[2]
  • However meta-analysis demonstrated no mortality difference overall and only in the subgroup with cultures positive for Streptococcus pneumoniae and not those for Haemophilus influenzae or Neisseria meningitidis[3]
  • Dexamethasone has been shown to decrease blood-brain permeability and therefore antibiotic penetration into subarachnoid space specifically with Vancomycin[4] However increasing the serum concentration of Vancomycin may increase the CSF levels and can possibly counteract the effects from dexamethasone
  • The Infectious Disease Society of America recommends the use of dexamethasone in all patients with suspected Strep. Pneumoniae meningitis. [5] and continuation of the dexamethasone as an in-patient can be continued based on the culture and gram stain results of the CSF
    • Suspicion for pneumococcal meningitis can be based on the inclusion criteria from the De Gans Study
  1. ↑ Bhatt SM et al. Progression of hearing loss in experimental pneumococcal meningitis: correlation with cerebrospinal fluid cytochemistry. J Infect Dis. 1993;167(3):675
  2. ↑ EBQ:De Gans - Steroids for Bacterial Meningitis
  3. ↑ Brouwer MC, McIntyre P, de Gans J, Prasad K, van de Beek D. Corticosteroids for Acute Bacterial Meningitis. Cochrane Database of Systematic Reviews 2010, Issue 9.
  4. ↑ Ricard JD et al. Levels of vancomycin in cerebrospinal fluid of adult patients receiving adjunctive corticosteroids to treat pneumococcal meningitis: a prospective multicenter observational study. Clin Infect Dis. 2007;44(2):250
  5. ↑ Tunkel AR et al. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis. 2004;39(9):1267
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