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Dexamethasone improved disability in acute bacterial meningitis

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 QUESTION: In patients with acute bacterial meningitis, does adjunctive treatment with dexamethasone improve outcomes more than placebo?


Randomised (allocation concealed*), blinded {clinicians, patients, data collectors, outcome assessors, data analysts, data monitoring committee, and manuscript writers},* placebo controlled trial with 8 weeks of follow up.


52 centres in the Netherlands, Belgium, Germany, Denmark, and Austria.


301 patients (mean age 45 y, 56% men) who had suspected meningitis in combination with cloudy cerebrospinal fluid, bacteria in cerebrospinal fluid on Gram staining, or cerebrospinal fluid leukocyte count >1000/mm3. Exclusion criteria included hypersensitivity to β lactam antibiotics or corticosteroids; cerebrospinal shunt; antibiotics in the past 48 hours; and history of active tuberculosis or fungal infection, head trauma, neurosurgery, or peptic ulcer disease. All patients were included in the analysis.


Patients …

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  • Source of funding: NV Organon.

  • For correspondence: Dr J de Gans, University of Amsterdam, Amsterdam, The Netherlands. j.degans{at}

  • Abstract and commentary also appear in ACP Journal Club.

  • * See glossary.

  • Information provided by author.