Meningococcal meningitis, dexamethasone, and Class III evidence

摘要

In bacterial meningitis, lysis of bacteria during treatment triggers the release of cytokines that increase intrathecal inflammation. Studies with animals have shown that adjunctive treatment with glucocorti-coids reduces both the inflammatory response and neurologic sequelae. Such treatment in humans, however, has been controversial for decades despite 44 clinical trials (29 randomized) and 10 meta-anal-yses. The most recent Cochrane review concluded that adjunctive dexamethasone significantly reduced mortality in meningitis due to Streptococcus pneu-moniae but not Neisseria meningitidis, with benefit in adults and children in high-income but not low-income countries.5 Dexamethasone was not associated with serious adverse effects, and the authors recommended a 4-day regimen of 0.6 mg/kg/day given before or with the first dose of antibiotic.