Should Dexamethasone be Part of Routine Therapy of Bacterial Meningitis in Industrialised Countries?

Although the first study of adjuvant corticosteroid therapy in bacterial meningitis was published over 40 y ears ago, (1) its value remains controversial in 2004. There was minimal evidence of reduction in mortality or severe sequelae in early trials. (2) Interest was rekindled following the publication of results of two trials conducted in Dallas by Dr George McCracken and colleagues, which demonstrated for the first time a reduction in hearing loss as a specific benefit of corticosteroid therapy in childhood meningitis. (3) However, almost 80% of participants in the Dallas trials had meningitis due to Haemophilus influenzae type b (Hib) which became a rare cause of childhood bacterial meningitis in most industrialised countries by the mid 1990s following the success of Hib immunisation programs. (4) Numerous commentators opined that adjunctive corticosteroid therapy could not be generally recommended on three main grounds—uncertain value for organisms other than Hib, the possibility of adverse effects especially on non-hearing deficits and the possibility that benefit was confined to certain types or timing of antibiotic therapy.(5)