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November 14, 2002

Steroid May Cut Death Risk of Bacterial Meningitis

From: Reuters, UK
Nov. 14, 2002

By Amy Norton

NEW YORK (Reuters Health) - Adding the corticosteroid dexamethasone to standard treatment for bacterial meningitis may cut adult patients' risk of death and disability from the infection, researchers in the Netherlands report.

They found that giving the steroid to patients along with antibiotics lowered their risk of dying or suffering an "unfavorable outcome," according to a report in the November 14th issue of The New England Journal of Medicine.

Meningitis is an infection of the membranes that surround the brain and spinal cord, usually caused by a virus or bacterium. Symptoms include a high fever, severe headache and neck stiffness.

Unlike viral meningitis, bacterial meningitis is a serious, potentially fatal condition. Antibiotics are an effective treatment, but the infection can damage the brain and have long-term complications such as hearing loss and speech problems. Some research has suggested that corticosteroid treatment, by reducing inflammation around the brain and spinal cord, may improve the outlook of bacterial meningitis patients.

"It is not only important to kill the bacteria with antibiotics, but it is also important to reduce the inflammation in the central nervous system," explained the study's lead author, Dr. Jan de Gans of the University of Amsterdam.

Based on these new findings, de Gans told Reuters Health, he and his colleagues believe dexamethasone should be given to all patients with bacterial meningitis--with the steroid started before or along with the first antibiotic dose.

The study received partial support from the drug company NV Organon, which supplied the dexamethasone.

De Gans and his colleagues randomly assigned 301 adult patients to take either dexamethasone or an inactive placebo along with standard antibiotic treatment. The corticosteroid was given either just before or at the same time as the first antibiotic dose, and then every 6 hours for 4 days.

Over 8 weeks, the researchers found, the risk of death among dexamethasone patients was less than half that of placebo patients--7% died, compared with 15% of those not given the drug. Treatment was also tied to a lower risk of so-called unfavorable outcomes, meaning moderate to severe disability limiting patients' ability to work or to care for themselves.

The benefit of dexamethasone was seen primarily in patients with pneumococcal meningitis, caused by the bacterium Streptococcus pneumoniae--as opposed to those with meningococcal meningitis, caused by the Neisseria meningitidis bacterium. The two bacteria are the major causes of bacterial meningitis in the US.

However, de Gans noted, there was a "trend" toward fewer poor outcomes among meningococcal meningitis patients treated with dexamethasone.

"Our opinion is that patients with meningococcal meningitis should also be treated with dexamethasone," the researcher said.

The authors of an editorial published with the report agree that dexamethasone appears appropriate for most pneumococcal meningitis patients, but advise stopping the drug if a patient is found be infected with a bug other than S. pneumoniae.

"We believe that routine use of...dexamethasone therapy is warranted in most adults with suspected pneumococcal meningitis," write Dr. Allan R. Tunkel of Drexel University in Philadelphia, Pennsylvania, and Dr. W. Michael Scheld of the University of Virginia Health System in Charlottesville.

However, they add, "if the meningitis is found not to be caused by S. pneumoniae, dexamethasone therapy should be discontinued."

The editorialists also advise that certain patients, including those who've already received antibiotics, not be given dexamethasone therapy.

SOURCE: The New England Journal of Medicine 2002;347:1549-1556, 1613-1614.

© Reuters 2002. All rights reserved.