Dexamethasone and long-term survival in bacterial meningitis.
Author(s): Fritz D, Brouwer MC, van de Beek D.
Affiliation(s): Department of Neurology, Center of Infection and Immunity Amsterdam, Academic
Medical Center, Amsterdam, The Netherlands.
Publication date & source: 2012, Neurology. , 79(22):2177-9
BACKGROUND: Data on the long-term effect of dexamethasone on survival in
bacterial meningitis are lacking.
METHODS: A long-term follow-up study of the European Dexamethasone in Adulthood
Bacterial Meningitis Study was performed. In this double-blind, randomized
clinical trial, 301 patients were randomly assigned to receive adjunctive
dexamethasone (n = 157) or placebo (n = 144) between June 1993 and December 2001.
We obtained survival data of patients using the Dutch Municipal Population
Register.
RESULTS: Death had occurred in 32 of 301 included patients (11%) at the primary
outcome measurement 8 weeks after randomization. Follow-up was obtained for 228
of 246 evaluable patients (93%), with median follow-up of 13 years. Overall, 31
of 144 patients (22%) in the dexamethasone group died and 44 of 134 patients
(33%) in the placebo group died (log-rank p = 0.029). After the primary end point
of the study at 8 weeks, 20 patients in the dexamethasone group died and 23
patients in the placebo group died (log-rank p = 0.27), with age being the sole
predictor of death (p < 0.001).
CONCLUSIONS: In adults with community-acquired bacterial meningitis, the survival
benefit from adjunctive dexamethasone therapy is obtained in the acute phase of
the disease and remains for years.
CLASSIFICATION OF EVIDENCE: This study of a population of Dutch patients shows
Class III evidence that dexamethasone provides an extended survival benefit in
patients treated for bacterial meningitis, and this survival benefit extends as
long as 20 years.
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