Dexamethasone Therapy Improves Meningitis Outcomes

Use on national scale tied to large improvement in pneumococcal meningitis prognosis
By Beth Gilbert
HealthDay Reporter

WEDNESDAY, Sept. 29 (HealthDay News) -- Therapy with dexamethasone has been widely implemented in the Netherlands as an adjunctive treatment of pneumococcal meningitis, and there subsequently has been substantial improvement in the prognosis of the disease on a national level, according to research published online Sept. 29 in Neurology.

Matthijs C. Brouwer, M.D., of the Academic Medical Center in Amsterdam, Netherlands, and colleagues evaluated all cases of community-acquired pneumococcal meningitis in Dutch patients over 16 years of age between March 2006 and January 2009 (357 episodes). Clinical characteristics and outcome were compared with a similar nationwide cohort of 352 patients with pneumococcal meningitis from a previous period (1998 to 2002) prior to implementation of guidelines recommending dexamethasone therapy.

The investigators found that dexamethasone was started with or prior to the first dose of antibiotics in 84 percent of episodes during 2006 to 2009 and 3 percent during 1998 to 2002. An unfavorable outcome was found at discharge in 39 percent between 2006 and 2009 and 50 percent between 1998 and 2002 (odds ratio, 0.63). Rates of death were 20 percent during 2006 to 2009 and 30 percent during 1998 to 2002. In addition, rates of hearing loss were 12 percent between 2006 and 2009 and 22 percent between 1998 and 2002.

"This study provides Class III evidence that dexamethasone given every six hours for four days reduced the proportion of patients with unfavorable outcome and reduced mortality in pneumococcal meningitis in adults," the authors write.

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