Dexamethasone treatment for bacterial meningitis

Meningitis and encephalitis in children. An update

Over the course of the past decade, much has changed on the landscape of meningitis and encephalitis in children. West Nile virus has emerged in the United States as a new etiologic pathogen causing encephalitis. Human herpesvirus-6 has been identified as a cause of encephalitis and febrile seizures. Lymphocytic choriomeningitis virus has been identified as an underrecognized neuroteratogen. The emergence of penicillin-resistant Streptococcus pneumoniae has complicated the treatment of bacterial meningitis, whereas the Haemophilus influenzae vaccine has fundamentally altered the disease's epidemiology. The recognition that much of the neuropathologic change induced by bacterial meningitis is inflammation mediated has paved the way to the demonstration that dexamethasone can substantially improve the outcome of bacterial meningitis in children. Although much progress has been made toward understanding, treating, and preventing these important infections, much remains to be learned.

Outcome of paediatric bacterial meningitis 1979-1989

OBJECTIVE

To determine the outcome of all cases of paediatric bacterial meningitis over the 11-year period 1979-1989 and discuss the role of adjunctive therapy with dexamethasone.

DESIGN AND SETTING

The study was performed by retrospective case review at Flinders Medical Centre, a general teaching hospital.

RESULTS

There were 80 episodes in 79 patients. The age range was 2 days to 15 years (mean, 1.7 years). Haemophilus influenzae type b was the commonest organism (60 of 80 cases; 75%). There were five deaths (6.3%). Sensorineural hearing loss was found in six of 71 children (8.5%) and was bilateral and severe in four (5.6%). Other problems included learning difficulties (12.7%), motor problems (7%), speech delay (7%), hyperactivity (4.2%), blindness (2.8%), obstructive hydrocephalus (2.8%) and recurrent seizures (2.8%).

CONCLUSIONS

Bacterial meningitis remains a disease with significant morbidity and mortality. Adjunctive therapy with dexamethasone should be considered, and vaccination against Haemophilus influenzae type b should be routine.