Corticosteroid Administration and Outcome of Adolescents and Adults With Acute Bacterial Meningitis: A Meta-analysis

May 2009
Mayo Clinic Proceedings;May2009, Vol. 84 Issue 5, p403
Academic Journal
OBJECTIVE: To systematically assess the effect of the adjunctive administration of corticosteroids in the treatment of acute bacterial meningitis. METHODS: We performed a systematic review and meta-analysis by searching several databases for reports (published from January 1966 through February 2008) of placebo-controlled randomized trials of corticosterold use In the treatment of adolescents and adults with acute bacterial meningitis. We used random-effects models. Sources of heterogeneity were explored by preplanned subgroup analyses. RESULTS: The 4 eligible trials (published between 1999 and 2007) were of high methodological quality and included 1261 adult patients. Overall, the short-term mortality rate associated with corticosterold administration was not significantly lower than that associated with placebo (relative risk ERR), 0.81; 95% confidence interval [CI], 0.54-1.20; P=54%). A significant interaction was found between the effect of corticosteroids and the Income status of the country (P=.02) and the prevalence of Infection with human immunodeficiency virus (HIV) among study populations (P=.03). The administration of corticosteroids resulted In a lower short-term mortality rate than did the administration of placebo in high-income countries (pooled RR, 0.5; 95% Cl, 0.27-0.92; P=0%) and In the studies with a low prevalence of infection with HIV (RR, 0.66; 95% Cl, 0.44-0.99; P=0%). In studies from high-income countries, the number needed to treat with corticosteriods to prevent 1 death and 1 neurologic sequela was 12.5 (95% CI, 7.1-100.0) and 11.0 (95% CI, 5.6-100.0), respectively. CONCLUSION: Our meta-analysis suggests that the adjunctive administration of corticosteroids is beneficial in the treatment of adolescents and adults with bacterial meningitis in patient populations similar to those seen In high-income countries and in areas with a low prevalence of HIV infection.


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