Adjunctive dexamethasone in adults with meningococcal meningitis.

Abstract

OBJECTIVES:

We evaluated the implementation and effectiveness of adjunctive dexamethasone in adults with meningococcal meningitis.

METHODS:

We compared 2 Dutch prospective nationwide cohort studies on community-acquired meningococcal meningitis. A total of 258 patients with CSF culture-proven meningitis were enrolled between 1998 and 2002, before routine dexamethasone therapy was introduced, and 100 patients from March 2006 to January 2011, after guidelines recommended dexamethasone.

RESULTS:

Dexamethasone was administered in 43 of 258 (17%) patients in the 1998-2002 cohort and in 86 of 96 (90%) patients in the 2006-2011 cohort (p < 0.001), and was started with or before the first dose of antibiotics in 12 of 258 (5%) and 85 of 96 (89%) patients (p < 0.001). Rates of unfavorable outcome were similar between cohorts (12 of 100 [12%] vs 30 of 258 [12%]; p = 0.67), also after correction for meningococcal serogroup. The rates of hearing loss (3 of 96 [3%] vs 19 of 237 [8%]; p = 0.10) and death (4 of 100 [4%] vs 19 of 258 [7%]; p = 0.24) were lower in the 2006-2011 cohort, but this did not reach significance. The rate of arthritis was lower in patients treated with dexamethasone (32 of 258 [12%] vs 5 of 96 [5%], p = 0.046). Dexamethasone was not associated with adverse events.

CONCLUSIONS:

Adjunctive dexamethasone is widely prescribed for patients with meningococcal meningitis and is not associated with harm. The rate of arthritis has decreased after the implementation of dexamethasone.

CLASSIFICATION OF EVIDENCE:

This study provides Class III evidence that adjuvant dexamethasone in adults with meningococcal meningitis does not increase negative outcomes such as deafness, death, or negative Glasgow Outcome Scale measures.

• Authors: Sebastiaan G B Heckenberg, Matthijs C Brouwer, Arie van der Ende, Diederik van de Beek
• Journal: Neurology (Neurology) Vol. 79 Issue 15 Pg. 1563-9 (Oct 09 2012) ISSN: 1526-632X [Electronic] United States
• PMID: 22972648 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Anti-Bacterial Agents
• Glucocorticoids
• Dexamethasone

Topics

• Adult
• Aged
• Anti-Bacterial Agents (adverse effects, therapeutic use)
• Dexamethasone (adverse effects, therapeutic use)
• Female
• Glasgow Outcome Scale
• Glucocorticoids (adverse effects, therapeutic use)
• Humans
• Male
• Meningitis, Meningococcal (drug therapy)
• Middle Aged
• Prospective Studies
• Treatment Outcome