| Drug Insight: steroids in CNS infectious diseases--new indications for an old therapy. | |
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MedLine Citation:
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PMID: 18256681 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Infectious diseases of the CNS lead to overwhelming inflammatory processes within the brain and spinal cord that contribute substantially to patient morbidity and mortality. Pharmacological strategies to modulate inflammation have been investigated, although the resulting guidelines have sometimes been contradictory. Steroids have been proposed as adjunctive treatments for bacterial meningitis, tuberculous meningitis and herpes simplex virus encephalitis. Well-designed randomized controlled trials have established dexamethasone as an adjunctive therapy for adult patients receiving antibiotics for bacterial meningitis, and physicians prescribing the initial antibiotics need to be aware of current guidelines. Morbidity and mortality in patients with tuberculous meningitis exceeds 50%. Steroid treatments reduce mortality through an as yet unknown mechanism, although their effects on morbidity are less clear. Herpes simplex virus encephalitis is also associated with considerable morbidity and mortality. Despite a lack of randomized trials, there is some evidence that steroids used alongside antiviral therapy might be beneficial in this condition. As we discuss in this Review, systemic steroid treatment is an important aspect of treatment regimens for CNS infectious diseases, and the recent literature provides guidelines for the use of steroids in combination with appropriate antimicrobial therapy. |
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Authors:
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Michael T Fitch; Diederik van de Beek |
Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't; Review |
Journal Detail:
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Title: Nature clinical practice. Neurology Volume: 4 ISSN: 1745-8358 ISO Abbreviation: - Publication Date: 2008 Feb |
Date Detail:
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Created Date: 2008-02-07 Completed Date: 2008-04-08 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101261799 Medline TA: Nat Clin Pract Neurol Country: England |
Other Details:
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Languages: eng Pagination: 97-104 Citation Subset: IM |
Affiliation:
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Department of Neurology, Center of Infection and Immunity Amsterdam, University of Amsterdam, Academic Medical Center, Amsterdam, The Netherlands. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Animals Central Nervous System Diseases / drug therapy*, microbiology, mortality Communicable Diseases / drug therapy*, microbiology, mortality Dexamethasone / therapeutic use Humans Steroids / therapeutic use* |
| Chemical | |
Reg. No./Substance:
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0/Steroids; 50-02-2/Dexamethasone |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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