We enrolled 200 infants and older children with
bacterial meningitis in two prospective double-blind, placebo-controlled trials to evaluate the efficacy of
dexamethasone therapy in addition to either
cefuroxime (Study 1) or
ceftriaxone (Study 2). Altogether, 98 patients received placebo and 102 received
dexamethasone (0.15 mg per kilogram of
body weight every six hours for four days). At the beginning of
therapy, the clinical and demographic characteristics of the patients in the treatment groups were comparable. The mean increase in the cerebrospinal fluid concentration of
glucose and the decreases in
lactate and
protein levels after 24 hours of
therapy were significantly greater in those who received
dexamethasone than in those who received placebo (
glucose, 2.0 vs. 0.4 mmol per liter [36.0 vs. 6.9 mg per deciliter], P less than 0.001;
lactate, 4.0 vs. 2.1 mmol per liter [38.3 vs. 19.8 mg per deciliter], P less than 0.001; and
protein, 0.64 vs. 0.25 g per liter [64.0 vs. 25.3 mg per deciliter], P less than 0.05). One patient in the placebo group in Study 1 died. As compared with those who received placebo, the patients who received
dexamethasone became afebrile earlier (1.6 vs. 5.0 days; P less than 0.001) and were less likely to acquire moderate or more severe bilateral
sensorineural hearing loss (15.5 vs. 3.3 percent; P less than 0.01). Twelve patients in the two placebo groups (14 percent) had severe or profound
bilateral hearing loss requiring the use of a
hearing aid, as compared with 1 (1 percent) in the two
dexamethasone groups (P less than 0.001). We conclude that
dexamethasone is beneficial in the treatment of infants and children with
bacterial meningitis, particularly in preventing
deafness.