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Use of corticosteroids along with antibiotics for children with bacterial meningitis may not affect outcomes

Children and adults stricken with bacterial meningitis, a serious infection of fluid in the spinal cord and surrounding the brain, can suffer brain damage and even death within hours or days. Rapid treatment with antibiotics is critical. Use of corticosteroids with or shortly before the first dose of antibiotics significantly reduces mortality among adults felled by bacterial meningitis. Although use of adjuvant corticosteroids for children with the condition is increasing, a new study found no association between this therapy and children's time to death or hospital discharge.

Researchers at the Center for Education and Research on Therapeutics (CERT) at the University of Pennsylvania School of Medicine suggest more studies be done to explore the possible benefit of corticosteroid use for children with bacterial meningitis before it becomes routine. They retrospectively studied the association between use of adjuvant steroids among young children (median age of 9 months) discharged with bacterial meningitis from 27 children's hospitals in different States with time to death and hospital discharge.

The most common cause of meningitis in this group was Streptococcus pneumoniae. Adjuvant corticosteroids were administered to nearly 9 percent of the 2,780 children. The overall mortality rate was 4.2 percent, with 2.2 percent of children dying within a week and 3.1 percent dying within 28 days after hospital admission. Adjuvant corticosteroids did not reduce children's deaths regardless of their age. This therapy also did not affect their time to hospital discharge.

Guidelines from the American Academy of Pediatrics acknowledge the unclear benefits of this therapy for children with bacterial meningitis, stating that use of dexamethasone "may be considered after weighing the potential benefits and risks."

The study was supported in part by a CERT grant from the Agency for Healthcare Research and Quality (HS16946). For more information on the CERT program, please visit http://www.ahrq.gov More details are in "Corticosteroids and mortality in children with bacterial meningitis," by Jillian Mongelluzzo, B.A., Zeinab Mohamad, M.S., Thomas R. Ten Have, Ph.D., and Samir S. Shah, M.D., M.S.C.E., in the May 7, 2008, Journal of the American Medical Association 299(17), pp. 2048-2055.

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