Early Steroid Therapy for Meningitis Proves to be Handy
Steroids are considered as an ancient therapy to bacterial meningitis but a recent study put steroids in a different light, showing that if steroids like dexamethasone in conjunction with the first dose of antibiotic could be administered to adults with bacterial meningitis early on, the risks of unfavorable outcome and death could be minimized.
Based on the Glasgow Outcome Scale, a well-validated scale frequently used in trials involving stroke and other brain injuries, treatment with dexamethasone substantially reduced the risks of unfavorable outcome (relative risk 0.59, 95% confidence interval 0.37-0.94) and death (relative risk 0.48, 95% confidence interval 0.24-0.96). In meningitis caused by pneumococcal infections (streptococcus pneumoniae,), death was reduced to 14 percent with dexamethasone from 34 percent with placebo.
The study also showed the treatment of bacterial meningitis with steroids has no side effects like increased neurological disability in the surviving patients, or any steroid-induced complications. In addition, steroid therapy in conjunction with antibiotic does not increase the risk of gastrointestinal bleeding. Gastrointestinal bleeding is a common side effect of a prolonged steroid therapy but the study indicated no sign of such adverse effect.
The study conducted by Diederik van de Beek, MD, for the European Dexamethasone in Adulthood Bacterial Meningitis Study Investigators was a result of a randomized, double-blind, multicenter, placebo-controlled trial of 301 adults with bacterial meningitis conducted in 2002. The trial of 301 adults showed that dexamethasone administered 15 to 20 minutes before or in conjunction with the first dose of antibiotic and were subsequently given every six hours for four days improved the patients’ chances of survival.
So far the steroid therapy proves to be beneficial to patients whose bacterial meningitis was caused by Streptococcus pneumoniae, or pneumococcus, the most common cause of bacterial meningitis in adults and children. But as dexamethasone treatment did not lead to increases in major adverse effects, van de Beek and his colleague recommend the use of adjunctive steroids for patients with community-acquired bacterial meningitis as long as they do not have septic shock, irrespective of the bacterial source of meningitis.
Nevertheless, the study provided clinicians with clear evidence-based guidelines for treatment of bacterial meningitis with adjunctive steroids.
It was in the 1950s when adjunctive treatment with steroids for bacterial meningitis was first reported. As early as then the treatment of bacterial meningitis indicated improved outcomes for patients treated with antibiotics in conjunction with adrenocorticotropic hormone and hydrocortisone. A successive study supported steroid’s role in treating bacterial meningitis when results of the said study showed that individuals with bacterial meningitis treated with antibiotics plus steroids within 12 to 24 hours of admission had better outcomes than patients managed with antibiotics alone.
Bacterial meningitis is a serious infection of the fluid in the spinal cord and the fluid that surrounds the brain. It occurs in between 2.6 and 6 adults per 100,000 per year in developed countries, and might be up to 10 times more prevalent in some areas of developing countries, according to the study entitled “Drug Insight: Steroids in CNS Infectious Diseases -- New Indications for an Old Therapy” published in Nature Clinical Practice Neurology.
- Dexamethasone in Adults with Bacterial Meningitis by Jan de Gans, Ph.D., Diederik van de Beek, M.D., for the European Dexamethasone in Adulthood Bacterial Meningitis Study Investigators. http://content.nejm.org/cgi/content/full/347/20/1549.
- Drug Insight: Steroids in CNS Infectious Diseases -- New Indications for an Old Therapy http://www.medscape.com/viewarticle/569256_1