Corticosteroids not linked with reduced risk of death for children with bacterial meningitis

The overall median length of stay was 11 days, with the median length of stay for children who received corticosteroids being 12 days, and the median length of stay for the children who did not receive corticosteroids being 10 days. The unadjusted difference in time to hospital discharge was not statistically significant. Length of hospital stay, analyzed as time to hospital discharge, was not associated with the administration of adjuvant corticosteroids for any age group.

“Our study results of no difference in mortality in children who received or did not receive corticosteroid therapy may differ from results of studies of adults for several reasons. First, adults may have different predisposing factors for meningitis or a different inflammatory response, either of which may alter the course of disease compared with children. Second, the case fatality rate in pneumococcal meningitis in children is lower in comparison with the case fatality rate in adults with pneumococcal meningitis (4.2 percent vs. 34 percent, respectively). Our study could have been underpowered to determine a difference in mortality when case fatality rates are low in children with bacterial meningitis,” the authors write.

“… adjuvant corticosteroid use in the treatment of bacterial meningitis appears to be increasing. A randomized trial is warranted to explore the possible benefit of adjuvant corticosteroid therapy on both morbidity and mortality in children with bacterial meningitis before such corticosteroid use becomes routine,” the researchers conclude.

(JAMA. 2008;299[17]:2048-2055. Available pre-embargo to the media at www.jamamedia.org)

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