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November 14, 2002

Steroid Cuts Death, Disability from Meningitis

Nov. 14, 2002

A study finds that combining dexamethasone with antibiotics markedly raises the odds of a better outcome from the infection.

By Adam Marcus
HealthScoutNews Reporter

WEDNESDAY, Nov. 13 (HealthScoutNews) -- People with bacterial infections of their brain and spinal fluid are twice as likely to survive the illness if they receive a steroid in addition to antibiotics, European researchers have found.

Doctors now prescribe dexamethasone to children who have bacterial meningitis, on the strength of evidence that the drug can reduce the risk of hearing loss associated with the infection. The corticosteroid, which is also used in cancer therapy to block nausea, soothes inflammation in the brain and spinal fluid caused by antibiotics that can injure neurons and lead to permanent nerve damage.

"You have to not only kill the bacteria but you have to treat the severe inflammation in the central nervous system," said Jan de Gans, a neurologist at Amsterdam's Academic Medical Center and lead author of the study, which appears in tomorrow's issue of the New England Journal of Medicine.

De Gans and his colleagues at other clinics in Europe gave regular doses of intravenous dexamethasone to 157 men and women with bacterial meningitis every six hours for four days, starting the drug just before or when the patients received their first antibiotics. Another 144 patients got an identical-looking placebo solution along with their bug-killing drugs.

Dexamethasone plus antibiotics reduced the risk of death by about 50 percent, the researchers found, and cut the chances of coma, disability and hearing loss by roughly 40 percent.

Previous studies had found that high doses of the corticosteroid could lead to gastric bleeding, but the researchers didn't see an increase in this side effect.

Adding the steroid also appeared to be most effective for people whose meningitis was caused by Pneumococcus bacteria, which account for between 30 percent and 40 percent of these infections. About a quarter of patients who took both drugs suffered serious complications of their infection, compared with 52 percent of those on antibiotics alone.

The combination therapy appeared to work better than antibiotics alone in patients with meningitis caused by the Meningococcus bacteria, but the results weren't conclusive, the scientists said. Meningococcal bugs also make up 30 percent to 40 percent of cases.

"We're sure that all patients [with bacterial meningitis] have to be treated with dexamethasone," said Dr. Diederik van de Beek, a neurologist also at the Academic Medical Center and a co-author of the study.

The timing of dexamethasone is crucial, and animal studies have shown that the drug doesn't perform if given after antibiotic treatment starts, de Gans said. The reason is that antibiotics break apart bacteria, giving the immune system a feast of targets to attack. So if these drugs are already working before the immune system is pacified, the steroid can't do its job.

Dr. Allan Tunkel, a professor of medicine at Drexel University College of Medicine and co-author of an editorial accompanying the journal article, said he's not yet convinced that the combination treatment works well in meningitis caused by germs besides Pneumococcus. More studies are needed to determine that, he said.

But Tunkel said doctors should start acting on the latest findings immediately. "I believe this is a major advance, such that dexamethasone should really be considered" for patients with bacterial meningitis, he said.

Bacterial meningitis affects about 3,000 Americans a year, killing one in 10 who develop the infection and leaving one in 7 who survive it with some form of potentially serious disability. The disease's signature symptoms are high fever, headaches, and stiffness in the neck.

What To Do

To find out more about meningitis, try the Centers for Disease Control and Prevention or the Meningitis Foundation of America.

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