The Beneficial Effects Of early Dexamethasone Administration in Infants and Children with Bacterial Meningitis

Carla M. Odio, Idis Faingezicht, Maria Paris, Martin Nassar, Aristides Baltodano, Jodi Rogers, Xavier Sáez-Llorens, Kurt D. Olsen, George H. Mccracken

Research output: Contribution to journalArticlepeer-review

378 Scopus citations

Abstract

Background. In experimental models of meningitis and in children with meningitis, dexamethasone has been shown to reduce meningeal inflammation and to Improve the outcome of disease. Methods. We conducted a placebo-controlled, double-blind trial of dexamethasone therapy in 101 infants and children admitted to the National Children's Hospital, San José, Costa Rica, who had culture-proved bacterial meningitis or clinical signs of meningitis and findings characteristic of bacterial infection on examination of the cerebrospinal fluid. The patients were randomly assigned to receive either dexamethasone and cefotaxime (n = 52) or cefotaxime plus placebo (n = 49). Dexamethasone (0.15 mg per kilogram of body weight) was given 15 to 20 minutes before the first dose of cefotaxime and was continued every 6 hours thereafter for four days. Results. The demographic, clinical, and laboratory profiles were similar for the patients in the two treatment groups. By 12 hours after the beginning of therapy, the mean opening cerebrospinal pressure and the estimated cerebral perfusion pressure had improved significantly in the dexamethasone-treated children but worsened in the children treated only with cefotaxime (controls). At 12 hours meningeal inflammation and the concentrations of two cytokines (tumor necrosis factor α and platelet-activating factor) in the cerebrospinal fluid had decreased in the dexamethasone-treated children, whereas in the controls the inflammatory response in the cerebrospinal fluid had increased. At 24 hours the clinical condition and mean prognostic score were significantly better among those treated with dexamethasone than among the controls. At follow-up examination after a mean of 15 months, 7 of the surviving 51 dexamethasone-treated children (14 percent) and 18 of 48 surviving controls (38 percent) had one or more neurologic or audiologic sequelae (P = 0.007); the relative risk of sequelae for a child receiving placebo as compared with a child receiving dexamethasone was 3.8 (95 percent confidence interval, 1.3 to 11.5). Conclusions. The results of this study, in which dexamethasone administration began before the initiation of cefotaxime therapy, provide additional evidence of a beneficial effect of dexamethasone therapy in infants and children with bacterial meningitis. (N Engl J Med 1991; 324:1525–31.)

Original languageEnglish (US)
Pages (from-to)1525-1531
Number of pages7
JournalNew England Journal of Medicine
Volume324
Issue number22
DOIs
StatePublished - May 30 1991

ASJC Scopus subject areas

  • Medicine(all)

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