Dexamethasone for adult community-acquired bacterial meningitis: 20 years of experience in daily practice

Peterković, Vjerislav and Trkulja, Vladimir and Kutleša, Marko and Krajinović, Vladimir and Lepur, Dragan (2012) Dexamethasone for adult community-acquired bacterial meningitis: 20 years of experience in daily practice. Journal of Neurology, 259 (2). pp. 225-236. ISSN 0340-5354

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The aim of the study was to assess adjunctive intravenous dexamethasone in adult community-acquired bacterial meningitis (BM) in daily practice. Analysis of consecutive patients (1990-2009) with acute community-acquired bacterial meningitis in a single centre in Zagreb, Croatia, N = 304. Adjusted relative risks [RR, dexamethasone vs. no dexamethasone (control)] of Glasgow Outcome Scale (GOS) = 1 (death) and GOS = 5 (full recovery) at discharge/end of specific treatment were estimated considering demographics; co-morbidity; BM pathogenesis and on-admission characteristics, and cerebrospinal fluid (CSF) inflammation markers; causative agent and antibiotic use. Two hundred forty (79%) patients had proven BM (43.1% Streptococcus pneumoniae, any other agent ≤ 8.2%). No independent effects of dexamethasone on GOS = 1 or GOS = 5 were observed in the entire cohort (dexamethasone n = 119, control n = 185; RR = 1.06, 95% CI 0.77-1.45 and RR = 0.99, CI 0.83-1.20, respectively), microbiologically proven disease (dexamethasone n = 104, control n = 136; RR = 0.97, CI 0.69-1.38 and RR = 1.03, CI 0.82-1.28), pneumococcal disease (dexamethasone n = 71, control n = 60; RR = 0.95, CI 0.53-1.70 and RR = 0.82, CI 0.57-1.18), and also in other BM, subgroups based on consciousness disturbance, CSF markers, prior use of antibiotics and timing of appropriate antibiotic treatment. CSF markers did not predict the outcomes. Conclusions: Our experience does not substantiate the reported benefits of adjunctive dexamethasone in adult BM. Socio-economic and methodological factors do not seem to explain this discrepancy. Empirical use of dexamethasone in this setting appears controversial.

Item Type: Article
MeSH: Adolescent ; Adult ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents ; Anti-Inflammatory Agents/therapeutic use ; Chemotherapy, Adjuvant ; Community-Acquired Infections/cerebrospinal fluid ; Community-Acquired Infections/drug therapy ; Dexamethasone/therapeutic use ; Female ; Glasgow Outcome Scale ; Humans ; Inflammation/cerebrospinal fluid ; Inflammation/drug therapy ; Male ; Meningitis, Bacterial/cerebrospinal fluid ; Meningitis, Bacterial/drug therapy ; Middle Aged ; Recovery of Function/drug effects ; Young Adult
Departments: Katedra za farmakologiju
Katedra za infektologiju
Depositing User: Marijan Šember
Status: Published
Peterković, VjerislavUNSPECIFIED
Trkulja, VladimirUNSPECIFIED
Krajinović, VladimirUNSPECIFIED
Date: February 2012
Date Deposited: 19 Nov 2012 13:09
Last Modified: 21 Nov 2012 11:51
Subjects: /
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