A RETROSPECTIVE ANALYSIS OF THE USAGE OF DEXAMETHASONE TO TREAT BACTERIAL MENINGITIS IN ADULTS AND CHILDREN.

Abstract

Objectives: The study aims to evaluate the use of dexamethasone as additional therapy in bacterial meningitis (BM), particularly when any one of the adverse prognostic cerebrospinal fluid parameters (WBC lesser than 1000 per mm³, lactate greater than 10 mg per dL, or glucose lesser than 20 mg per dL) is present, with a focus on outcomes and complications. Methods: This retrospective cohort study was conducted at A. N. M. Medical College in India over 6 months from January 2023 to June 2023, involved 276 confirmed cases of bacterial meningitis. Patient data from the hospital registry were reviewed, applying inclusion criteria such as positive gram stain or CSF culture, CSF white cell count exceeding 1000/mm³, or cloudy CSF, while excluding cases of nosocomial BM, neurotrauma or neurosurgery history, and neonatal meningitis. Results: In this investigation of 276 BM patients, S. pneumoniae and N. meningitidis were the main causes of death, with rates of 19% and 2%, respectively, slightly lower than previously reported. As previously reported, S. pneumoniae cases had more negative outcomes, and the triad of symptoms was found in only 25% of patients but linked with nerve-related or auditory sequelae. Dexamethasone appears to be more beneficial in instances with low cerebrospinal fluid leukocyte counts (< 1000/mm³), although further research is needed to confirm this. Conclusion: This retrospective analysis suggests that dexamethasone may enhance outcomes in bacterial meningitis with specific cerebrospinal fluid characteristics. To confirm these findings, dexamethasone should be tested in clinical trials, especially in children, given the decline in infections in this population due to vaccination deployment. Recommendation: Considering the limitations of this retrospective analysis, prospective large-scale clinical trials are recommended to establish the efficiency of dexamethasone in diverse bacterial meningitis subgroups and to guide its routine use in clinical practice.

Keywords

• Bacterial meningitis
• Streptococcus pneumoniae
• Neisseria meningitides
• Cerebrospinal fluid