Template:Steroids Bacterial Meningitis
- 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
- ↑ Bhatt SM et al. Progression of hearing loss in experimental pneumococcal meningitis: correlation with cerebrospinal fluid cytochemistry. J Infect Dis. 1993;167(3):675
- ↑ EBQ:De Gans - Steroids for Bacterial Meningitis
- ↑ 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.
- ↑ 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
- ↑ Tunkel AR et al. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis. 2004;39(9):1267