Review: adjuvant corticosteroid therapy reduces death, hearing loss, and neurological sequelae in bacterial meningitis

doi:10.1136/ebm.9.2.48

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Evidence-Based Medicine 2004; 9:48
© 2004 BMJ Publishing Group Ltd.

Therapeutics

Review: adjuvant corticosteroid therapy reduces death, hearing loss, and neurological sequelae in bacterial meningitis

van de Beek D, de Gans J, McIntyre P, et al. Corticosteroids in acute bacterial meningitis. Cochrane Database Syst Rev 2003;(3):CD004305.

Q In children and adults with acute bacterial meningitis (ABM), is adjuvant corticosteroid therapy more effective than placebo for reducing mortality, hearing loss, and neurological sequelae?

Clinical impact ratings IM/Ambulatory care $*$ $*$ $*$ $*$ $*$ ${star}$ ${star}$ Internal medicine $*$ $*$ $*$ $*$ $*$ ${star}$ ${star}$ Neurology $*$ $*$ $*$ $*$ $*$ $*$ ${star}$ Infectious disease $*$ $*$ $*$ $*$ $*$ ${star}$ ${star}$

Key Words: adrenal cortex hormones • anti-inflammatory agents (steroidal) • meningitis (bacterial)

The first 150 words of the full text of this article appear below.

METHODS
Data sources studies were identified by searching the Cochrane Central Registerof Controlled Trials (2003), Medline (1966 to January 2003),EMBASE/Excerpta Medica (1974 to April 2002), and Healthline(1988 to April 2002); reviewing current trials published beforeApril 2002; scanning reference lists; hand searching abstractsof congresses; and contacting researchers and experts.

Study selection and assessment studies in any language were selected if they were randomisedcontrolled trials that compared any type of corticosteroid therapyadjuvant to antibiotics with placebo in patients with ABM andrecorded case fatality rates. 2 reviewers independently assessedthe quality of studies using the Jadad scale.

Outcomes mortality, severe hearing loss (bilateral hearing loss >60 dB or requiring bilateral hearing aids), and short term (dischargeto 6 wk) or long term (6 to 12 mo after discharge) neurologicalsequelae.

MAIN RESULTS
18 studies (1853 patients) met the selection criteria. Overall,fewer patients who received corticosteroids died . . . [Full text of this article]

Andrew M Morris, MD, MSc

McMaster University
Hamilton, Ontario, Canada