Document Detail

Adjunctive dexamethasone in adults with meningococcal meningitis.
MedLine Citation:
PMID:  22972648     Owner:  NLM     Status:  MEDLINE    
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.
Sebastiaan G B Heckenberg; Matthijs C Brouwer; Arie van der Ende; Diederik van de Beek
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't     Date:  2012-09-12
Journal Detail:
Title:  Neurology     Volume:  79     ISSN:  1526-632X     ISO Abbreviation:  Neurology     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-10-09     Completed Date:  2013-01-11     Revised Date:  2013-05-20    
Medline Journal Info:
Nlm Unique ID:  0401060     Medline TA:  Neurology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1563-9     Citation Subset:  AIM; IM    
Department of Neurology, Center of Infection and Immunity Amsterdam, The Netherlands.
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MeSH Terms
Anti-Bacterial Agents / adverse effects,  therapeutic use*
Dexamethasone / adverse effects,  therapeutic use*
Glasgow Outcome Scale
Glucocorticoids / adverse effects,  therapeutic use*
Meningitis, Meningococcal / drug therapy*
Middle Aged
Prospective Studies
Treatment Outcome
Reg. No./Substance:
0/Anti-Bacterial Agents; 0/Glucocorticoids; 50-02-2/Dexamethasone
Comment In:
Neurology. 2012 Oct 9;79(15):1528-9   [PMID:  22972640 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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