Bacterial meningitis is one of the most serious
infections in infants and children, with considerable morbidity and mortality. Despite the spreading of conjugated
vaccines against Haemophilus influenzae type b (Hib), the most important pneumococcal serotypes and serogroup C meningococcus has reduced the incidence of this
infection in developed countries, it still remains a global public health problem and an important cause of mortality and disability. Whether
corticosteroids should be used as a complementary
therapy to antibacterials is still not clear because of the disparate findings from clinical trials and clinical evidence. The aim of this review is to analyze the available evidence on the impact of
corticosteroid therapy in infants and children with
bacterial meningitis in developed countries in order to define whether they should be added routinely in the empiric
therapy of such disease. Our analysis concluded that in high-income countries
dexamethasone has shown good results to prevent
hearing loss in Hib
meningitis if administered before or at the same time as the first dose of
antibiotics.
Dexamethasone should be evaluated in
pneumococcal meningitis: it may be less beneficial in children with delayed presentation to medical attention and may be unfavourable in case of
cephalosporin-resistant pneumococci. On the contrary, there is no evidence to recommend the use of
corticosteroids in
meningococcal meningitis. Further studies that take into account the epidemiologic changes of recent years, consider enrolment based on the onset of symptoms and evaluate outcomes such as
hearing loss and neurologic sequelae with advanced techniques are urgently needed.