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Abstract
Objectives: We evaluated the implementation and effectiveness of adjunctive dexamethasone in adults with meningococcal meningitis.
Methods: We compared 2 Dutch prospective nationwide cohort studies on community-acquired meningococcal meningitis. A total of 258 patients with CSF culture-proven meningitis were enrolled between 1998 and 2002, before routine dexamethasone therapy was introduced, and 100 patients from March 2006 to January 2011, after guidelines recommended dexamethasone.
Results: Dexamethasone was administered in 43 of 258 (17%) patients in the 1998–2002 cohort and in 86 of 96 (90%) patients in the 2006–2011 cohort (p < 0.001), and was started with or before the first dose of antibiotics in 12 of 258 (5%) and 85 of 96 (89%) patients (p < 0.001). Rates of unfavorable outcome were similar between cohorts (12 of 100 [12%] vs 30 of 258 [12%]; p = 0.67), also after correction for meningococcal serogroup. The rates of hearing loss (3 of 96 [3%] vs 19 of 237 [8%]; p = 0.10) and death (4 of 100 [4%] vs 19 of 258 [7%]; p = 0.24) were lower in the 2006–2011 cohort, but this did not reach significance. The rate of arthritis was lower in patients treated with dexamethasone (32 of 258 [12%] vs 5 of 96 [5%], p = 0.046). Dexamethasone was not associated with adverse events.
Conclusions: Adjunctive dexamethasone is widely prescribed for patients with meningococcal meningitis and is not associated with harm. The rate of arthritis has decreased after the implementation of dexamethasone.
Classification of evidence: This study provides Class III evidence that adjuvant dexamethasone in adults with meningococcal meningitis does not increase negative outcomes such as deafness, death, or negative Glasgow Outcome Scale measures.
GLOSSARY
- cc=
- clonal complex;
- GOS=
- Glasgow Outcome Scale;
- MLST=
- multilocus sequence typing;
- NRLBM=
- Netherlands Reference Laboratory for Bacterial Meningitis.
Footnotes
Coinvestigators are listed on the Neurology® Web site at www.neurology.org.
Study funding: Supported by the Netherlands Organization for Health Research and Development (ZonMw NWO-Veni grant 2006 [916.76.023] and ZonMw NWO-Vidi grant 2010 [917.11.358], both to D.v.d.B.), the Academic Medical Center (AMC Fellowship 2008 to D.v.d.B.), and European Research Council (ERC Starting Grant [281156] to D.v.d.B.).
Editorial, page 1528
Supplemental data at www.neurology.org
- Received February 27, 2012.
- Accepted April 19, 2012.
- Copyright © 2012 by AAN Enterprises, Inc.
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