Rebound fever in bacterial meningitis: role of dexamethasone dosage.

Since introducing dexamethasone as adjuvant therapy to antibiotics for bacterial meningitis, we have noticed an increase in the number of cases with secondary fever. Therefore, we performed a retrospective analysis of the 19 consecutive cases occurring during the last 5 years. Six patients received dexamethasone for 4 days, 5 received a 2-day course of dexamethasone and 8 received antibiotics only. The etiologic agents included: Haemophilus influenzae (in 11 patients), Streptococcus pneumoniae (in 6) and Neisseria meningitidis (in 2). Among the 11 patients receiving dexamethasone, the fever remitted within 1-5 days (average 1.7 +/- 1.2) while among the 8 patients not receiving dexamethasone the initial fever lasted 1-17 days (average 5.3 +/- 1.7) (P = 0.009). There was secondary fever without a definable clinical or bacteriological source in 9 of 11 patients receiving dexamethasone and in none of those who were treated without steroids (P < 0.001). The secondary fever among those who received dexamethasone for 2 days was low grade (37.5 degrees-38 degrees C) and lasted for 1 day only, while among those who received dexamethasone for 4 days it was > 38 degrees C and more prolonged (7 +/- 2.3 days) (P < 0.03). Total days of fever were 2.2 +/- 0.2 days when dexamethasone was administered for 2 days only vs. 7.8 +/- 1.7 for the patients in each of the two other groups (P < 0.03). The relatively benign course with the 2-day regimen of dexamethasone makes us consider whether a 2-day course of dexamethasone might save costly evaluations of secondary fever and much concern. Further studies are needed in order to document the efficacy of this regimen in reducing neurological sequelae.