Document Detail


Drug Insight: steroids in CNS infectious diseases--new indications for an old therapy.
MedLine Citation:
PMID:  18256681     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Michael T Fitch; Diederik van de Beek
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  Nature clinical practice. Neurology     Volume:  4     ISSN:  1745-8358     ISO Abbreviation:  -     Publication Date:  2008 Feb 
Date Detail:
Created Date:  2008-02-07     Completed Date:  2008-04-08     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101261799     Medline TA:  Nat Clin Pract Neurol     Country:  England    
Other Details:
Languages:  eng     Pagination:  97-104     Citation Subset:  IM    
Affiliation:
Department of Neurology, Center of Infection and Immunity Amsterdam, University of Amsterdam, Academic Medical Center, Amsterdam, The Netherlands.
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MeSH Terms
Descriptor/Qualifier:
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:
0/Steroids; 50-02-2/Dexamethasone

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


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