DEXAMETHASONE IN THE TREATMENT OF ACUTE BACTERIAL MENINGITIS: THE EFFECT OF STUDY DESIGN ON THE INTERPRETATION OF RESULTS

Abstract

Low doses of dexamethasone (4.8 mg per meter squared of body area per day) were compared to a placebo as an adjunct to a standardized antimicrobial treatment of acute bacterial meningitis in 102 infants and children. In attempting to ensure an equal risk of complications and sequelae in the two treatment groups, we matched the patients by age, state of consciousness, and etiologic agent; analysis was based on 86 matched patients. Complications occurred in 8 patients in the dexamethasone treated group and in 18 of the placebo group; the complications were milder in the dexamethasone group. However, these results must be tempered by the observation that nearly all complications occurred among patients who had an elevated level of CSF-COT on admission or evidence of meningitis existing for several days before hospitalization; both factors have been noted previously to be associated with increased risk of complications. Since our results reflect differences that were inherent in the groups at the outset, we must conclude that we have not demonstrated that low doses of dexamethasone have any significant effect on the course or outcome of acute bacterial meningitis.