RCT

de Gans & van de Beek

Dexamethasone in Adults with Bacterial Meningitis

NEJM, 2002 · Prospective randomized double-blind multicenter trial (n=301)

Clinical question

Does adjunctive dexamethasone improve outcomes in adults with acute bacterial meningitis?

Population: Adults (>= 17 years) with suspected or confirmed acute bacterial meningitis
Intervention: IV Dexamethasone (10 mg every 6 h for 4 days) started before or with the first antibiotic dose
Comparator: Matching placebo infusion
Primary outcome: Unfavorable outcome (Glasgow Outcome Scale score 1-4) at 8 weeks
Result: Dexamethasone significantly reduced unfavorable outcome (15% vs 25%; RR 0.59, P=0.03) and all-cause mortality (7% vs 15%, P=0.04). Among patients with Streptococcus pneumoniae meningitis, mortality was reduced from 34% to 14% (RR 0.41, P=0.02).

What the trial found

Early dexamethasone significantly reduces death and severe hearing loss/neurological disability in adult pneumococcal meningitis.

Current guideline position

IDSA guidelines strongly recommend adjunctive dexamethasone (0.15 mg/kg q6h or 10 mg q6h for 4 days) initiated prior to or with the first dose of antibiotics in suspected or proven S. pneumoniae meningitis.

Clinical interpretation

Established the mandatory practice of giving 10 mg IV dexamethasone prior to or concurrently with empiric antibiotics.

Clinical Context & Relevant Topics (1)

Disease Reference

Acute Meningitis & Encephalitis

CT-before-LP criteria, CSF interpretation matrix, de Gans Dexamethasone timing, empiric age/host antimicrobial coverage + Ampicillin + Acyclovir, and neurocritical ICP management.

View Topic Context →