The role of corticosteroid therapy in children with pneumococcal meningitis.

The records of 97 infants and children with pneumococcal meningitis treated in Dallas, Tex, from 1984 to 1990 were reviewed to determine whether corticosteroid therapy improved disease outcome as has been demonstrated in patients with Haemophilus meningitis. Forty-one patients received corticosteroid therapy, 39 of whom were given dexamethasone in the conventional 4-day regimen. There were no significant differences in the demographic and clinical characteristics of steroid- and non-steroid-treated patients. In addition, there were no significant differences between treatment groups with regard to presence of seizures, subdural effusions, hydrocephalus, and positive cerebrospinal fluid cultures 24 hours after the start of treatment. When steroid therapy was given before or concurrently with antibiotic therapy, none of 30 steroid-treated vs 16 of 52 non-steroid-treated patients developed evidence of neurologic or cardiovascular instability after the first parenteral antibiotic dose was given. Among 86 survivors examined, significantly fewer steroid-treated patients had an adverse neurologic long-term outcome, including hearing impairment, compared with non-steroid-treated patients (four of 35 vs 14 of 43). This was also true for those patients with overwhelming meningeal infection. We believe that corticosteroid therapy is also beneficial in infants and children with pneumococcal meningitis.