Steroids for treating cerebral malaria.

BACKGROUND: Cerebral malaria is associated with swelling of the brain. Corticosteroid drugs could reduce the harmful effects of this swelling, but could also suppress host immunity to infection.
OBJECTIVES: This review aimed to assess the effects of steroids in patients with cerebral malaria in relation to survival and long-term disability. SEARCH STRATEGY: The Cochrane Controlled Trials Register, the Cochrane Infectious Diseases Group Trials Register, existing reviews, and contact with experts in the field. SELECTION CRITERIA: Randomised controlled trials comparing steroids and no steroids in otherwise identical treatments for patients with cerebral malaria. DATA COLLECTION AND ANALYSIS: Assessments of inclusion criteria, trial quality and data extraction were done by each author independently. The outcomes sought were death, death with life-threatening complications, other complications, and disability. MAIN
RESULTS: Two trials met the inclusion criteria. Out of a total of 143 patients, there were 30 deaths, distributed evenly between the steroid and the comparator group. The researchers reported clinical complications as the number of events in each trial arm, and did not exclude complications occurring in fatalities. This makes it difficult to interpret the reports of significantly more episodes of gastro-intestinal bleeding and seizures in the steroid group. No studies examined disability. REVIEWER'S
CONCLUSIONS: There is currently no evidence of benefit from steroids in this condition, but the small number of participants means it is difficult to exclude an effect on mortality in either direction. Data on clinical complications are difficult to assess.