Dexamethasone in meningococcal meningitis
| Citation | Study group | Study type (level of evidence) | Outcome | Key results | Comments |
|---|---|---|---|---|---|
| McIntyre et al (1997) | 848 children with bacterial meningitis with mean age in studies 1.2 to 7 y | Meta-analysis of 11 randomised controlled trials. Non-randomised studies assessed for adverse effects (1a) | Hearing loss and neurological outcome other than hearing loss | In H influenzae meningitis dexamethasone reduced severe hearing loss (OR 0.31, 95% CI 0.14 to 0.69). Pneumococcal meningitis OR 0.52 (95% CI 0.17 to 1.46). Protection against other neurological deficits was not statistically significant (OR 0.59, 95% CI 0.34 to 1.02) | Authors do not report a method for assessing validity. Difference between subgroups may be observed by chance. Potential publication bias |
| Thomas et al (1999) | 60 adult patients with bacterial meningitis | Multicentre, double blind, randomised trial (1b) | Rate of patients cured without clinical neurologic sequelae at 30 days | Rate of cured patients without neurological sequelae was not significant (p = 0.071) between the 2 groups. RRR of severe neurologic sequelae following dexamethasone therapy was 44% (95% CI −57 to 100) | Adult patient groups. First dose of dexamethasone was given within 3 h of first antibiotic dose rather than with or before the dose |
| Syrogiannopoulos et al (1994) | 118 children aged 2.5 mth to 15 y with suspected or proven bacterial meningitis | Single blind randomised control trial (1b) | Neurological and audiological assessment at 6 weeks and 4–24 months | No difference in the rate of neurologic and/or audiologic sequelae between 2 groups; RRR −135% (95% CI −11 to 100) | Both groups received dexamethasone |
| Schaad et al (1993) | 115 children (age 3 mth to 16 y) with suspected or confirmed bacterial meningitis | Double blind randomised control trial (1b) | Neurologic and audiologic test at 3, 9, and 15 months | 16% of 55 placebo recipients and 5% of 60 dexamethasone recipients had 1 or more neurologic/audiologic sequelae (p = 0.066); the relative risk of sequelae was 3.27 (95% CI 0.93 to 11.47) | 55% of children in control group and 62% in experimental group had H influenzae meningitis |
| Odio et al (1991) | 101 children aged 6 weeks to 13 years with suspected or proven bacterial meningitis | Double blind randomised controlled trial (1b) | Neurological follow up up to 12 months, audiologic follow up up to 24 months | Favourable neurological outcome in dexamethasone treated group; RRR 68% (95% CI 11 to 100) with NNT 6. No difference in audiologic sequelae between two groups; RRR 63% (95% CI −13 to 100) | Only 2 patients (4%) in dexamethasone group and none in control group had meningococcal meningitis |