Adjunctive dexamethasone in adults with meningococcal meningitis

作者：Heckenberg Sebastiaan G B; Brouwer Matthijs C; van der Ende Arie; van de Beek Diederik^*

来源：Neurology, 2012, 79(15): 1563-1569.

DOI：10.1212/WNL.0b013e31826e2684

Objectives: We evaluated the implementation and effectiveness of adjunctive dexamethasone in adults with meningococcal meningitis. %26lt;br%26gt;Methods: We compared 2 Dutch prospective nationwide cohort studies on community-acquired meningococcal meningitis. A total of 258 patients with CSF culture-proven meningitis were enrolled between 1998 and 2002, before routine dexamethasone therapy was introduced, and 100 patients from March 2006 to January 2011, after guidelines recommended dexamethasone. %26lt;br%26gt;Results: Dexamethasone was administered in 43 of 258 (17%) patients in the 1998-2002 cohort and in 86 of 96 (90%) patients in the 2006-2011 cohort (p %26lt; 0.001), and was started with or before the first dose of antibiotics in 12 of 258 (5%) and 85 of 96 (89%) patients (p %26lt; 0.001). Rates of unfavorable outcome were similar between cohorts (12 of 100 [12%] vs 30 of 258 [12%]; p %26lt; 0.67), also after correction for meningococcal serogroup. The rates of hearing loss (3 of 96 [3%] vs 19 of 237 [8%]; p = 0.10) and death (4 of 100 [4%] vs 19 of 258 [7%]; p = 0.24) were lower in the 2006-2011 cohort, but this did not reach significance. The rate of arthritis was lower in patients treated with dexamethasone (32 of 258 [12%] vs 5 of 96 [5%], p = 0.046). Dexamethasone was not associated with adverse events. %26lt;br%26gt;Conclusions: Adjunctive dexamethasone is widely prescribed for patients with meningococcal meningitis and is not associated with harm. The rate of arthritis has decreased after the implementation of dexamethasone.

• 出版日期2012-10