Faculty Opinions recommendation of Corticosteroids for bacterial meningitis in adults in sub-Saharan Africa.

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Abstract
The study suggests that, in the developing world, there is little justification for giving dexamethasone to patients with bacterial meningitis. This study was a randomized, double-blind, placebo-controlled trial of adjuvant dexamethasone therapy in adults with an admission diagnosis of bacterial meningitis in Malawi. The primary outcome parameter was death at 40 days after randomization. A total of 233 patients were assigned to the dexamethasone group and 232 to the placebo group. An intention-to-treat analysis showed that dexamethasone was not associated with a significant reduction in the risk of death, the outcomes of disability and death combined, hearing impairment, and adverse effects. Moreover, no significant differences in mortality between the dexamethasone and placebo group were found when the analysis was restricted to patients with pneumococcal meningitis. This study agrees with recent trials in Malawi, South America, and Europe {1-3}, but is in contrast to other trials in Vietnam and Europe {4, 5}. A definite explanation for the differences in the results between these trials is currently lacking, perhaps pathogenic changes were too far advanced in trials showing no beneficial effects of dexamethasone. Thus, the debate about the value of dexamethasone in acute bacterial meningitis will continue.

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