caa a22 4500 477069185 CHVBK 20180405111420.0 cr unu---uuuuu 170330e19960901xx s 000 0 eng 10.1007/BF02730800 doi (NATIONALLICENCE)springer-10.1007/BF02730800 Dexamethasone in bacterial meningitis: To use or not to use? [Elektronische Daten] [Aditya Kaul, Sulachni Chandwani] Permanent neurologic disabilities are seen in up to a quarter of survivors of bacterial meningitis despite major improvements in therapy. Experimental studies have demonstrated that most of the pathology in meningitis is mediated by inflammatory cytokines such as tumor necrosis factor (TNF) and interleukin-1 (IL-1), which are produced by host cells in response to bacterial invasion of the meninges. Dexamethasone has been used in a number of clinical trials to moderate the host response and to improve neurologic outcome of meningitis. Results of six randomized, placebo controlled trials are summarized in this review. Dexamethasone treatment did not lower mortality. Only a moderate, but not a significant reduction in the neurologic and audiologic sequelae was seen in dexamethasone recipients whenHaemophilus influenzae type b (Hib) was the causative agent of meningitis. Following routine use of Hib vaccine, meningitis caused by this agent has virtually disappeared in the USA. Hence, findings from these trials may no longer be applicable in countries with high rates of immunization against Hib. Presently, there is little or no evidence showing a benefit of dexamethasone therapy in meningitis caused byS. pneumoniae orN. meningitidis. Global emergence of penicillin and cephalosporin resistantS. pneumoniae has raised new concerns about the use of dexamethasone in pneumococcal meningitis. Since dexamethasone significantly decreases the penetration and concentration of vancomycin and ceftriaxone in the CSF and delays CSF sterilization, adjunctive dexamethasone therapy may increase the risk of treatment failure in meningitis caused by antibiotic resistant pneumococci. An antibiotic combination should be used in the treatment of meningitis caused by antibiotic resistant pneumococci, particularly if dexamethasone is also being administered concurrently. Dr. K C Chaudhuri Foundation, 1996 Meningitis nationallicence Dexamethasone nationallicence Haemophilus influenzae nationallicence Streptococcus pneumoniae nationallicence antibiotic resistance nationallicence Kaul Aditya Department of Pediatrics, Division of Pediatric Infectious Diseases and Immunology, New York University School of Medicine, 550, First Avenue, New York, USA aut Chandwani Sulachni Department of Pediatrics, Division of Pediatric Infectious Diseases and Immunology, New York University School of Medicine, 550, First Avenue, New York, USA aut The Indian Journal of Pediatrics Springer India 63/5(1996-09-01), 583-589 0019-5456 63:5<583 1996 63 12098 https://doi.org/10.1007/BF02730800 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/BF02730800 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Kaul Aditya Department of Pediatrics, Division of Pediatric Infectious Diseases and Immunology, New York University School of Medicine, 550, First Avenue, New York, USA aut NATIONALLICENCE 700 1- Chandwani Sulachni Department of Pediatrics, Division of Pediatric Infectious Diseases and Immunology, New York University School of Medicine, 550, First Avenue, New York, USA aut NATIONALLICENCE 773 0- The Indian Journal of Pediatrics Springer India 63/5(1996-09-01), 583-589 0019-5456 63:5<583 1996 63 12098 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer