EBQ:De Gans - Steroids for Bacterial Meningitis
incomplete Journal Club Article
de Gans JD, et al. "Dexamethasone in Adults with Bacterial Meningitis". The New England Journal of Medicine. 2002. 347(20):1549-1556.
PubMed Full text PDF
PubMed Full text PDF
Clinical Question
In patients with acute bacterial meningitis does dexamethasone improve outcomes when given in addition to standard antibiotic therapy?
Conclusion
Early treatment with dexamethasone in adults with acute bacterial meningitis improves outcomes. There is no increase in GI bleed.
Major Points
Study Design
Prospective, randomized, double-blinded, multi-center, controlled trial
Population
- N=301; randomly assigned to 1 of 2 groups
- 157 in dexamethasone group
- 144 in placebo group
Patient Demographics
| Group Characteristic | Dexamethasone | Placebo |
| Age (yr) | 44+/-18 | 46+/-20 |
| Bacteria + in gram stain of CSF | 74% | 69% |
| CSF WBC >1000/gram stain neg | 24% | 29% |
| Cloudy CSF only | 2% | 2% |
| Duration of symp prior to admission(median) | 24 | 24 |
| Seizures | 10% | 5% |
| CSF opening pressure | 37+/-13 | 34+/-14 |
| GCS (median) | 12 | 12 |
| Papilledema | 7% | 10% |
| CN palsy | 9% | 12% |
| Hemiparesis | 6% | 8% |
| CSF Strep Pneumo | 37% | 35% |
| CSF Nisseria | 32% | 33% |
| CSF other | 8% | 12% |
| CSF negative | 24 | 24 |
| CSF WBC (mean) | 8185 | 7438 |
| CSF Protein | 4.3+/-3.0 | 4.7+/-3.2 |
| CSF Glucose | 27+/-31 | 27+/-29 |
| Blood Cx + | 53% | 47% |
Inclusion Criteria
- Age 17 yrs or older AND
- Suspected meningitis with:
- Cloudy CSF OR
- Bacteria in CSF on gram stain OR
- CSF leukocyte count >1000
Exclusion Criteria
- Hypersensitivity to B-lactam antibiotics or steroids
- Pregnancy
- Cerebrospinal shunt
- Treatment with antibiotics within past 48 hours
- Active TB or fungal infection
- Recent head trauma, neurosurgery, or PUD
- Enrollment in other trial