Adjunctive dexamethasone therapy for bacterial meningitis in adults: a meta-analysis of randomized controlled trials.

The objective of this review was to study the effectiveness of dexamethasone for the treatment of adult patients with bacterial meningitis. Data was extracted from randomized controlled trials (RCTs) comparing dexamethasone with placebo or no treatment and pooled using meta-analysis techniques. Treatment with dexamethasone was associated with a non-significant lower mortality than placebo or no treatment [odds ratio (OR) = 0.68, 95% confidence interval (CI) 0.45-1.04]. If a RCT conducted in Malawi was excluded from the analysis, dexamethasone was associated with lower mortality than placebo or no treatment (OR = 0.58, 95% CI 0.40-0.83). Dexamethasone was associated with lower mortality in patients with definite meningitis (OR = 0.55, 95% CI 0.31-0.96), short duration of symptoms (OR = 0.61, 95% CI 0.38-1.00), Streptococcus pneumoniae meningitis (OR = 0.26, 95% CI 0.08-0.78), patients in countries with high (OR = 0.45, 95% CI 0.23-0.87) and medium Human Development Index (OR = 0.65, 95% CI 0.42-1.00). No benefit was seen in patients with longer duration of symptoms (OR = 0.80, 95% CI 0.47-1.36) or no antibiotic use (OR = 0.68, 95% CI 0.36-1.28). Dexamethasone was associated with fewer episodes of hearing impairment in high quality RCTs (OR = 0.64, 95% CI 0.43-0.94). The currently available evidence suggests that dexamethasone should be administered to all adult patients with bacterial meningitis. Large studies are needed to clarify the role of the duration of symptoms, disease severity, and antibiotic administration before the initiation of treatment with dexamethasone on modifying the outcomes.