Corticosteroids not linked with reduced risk of death for children with bacterial meningitis

May 06, 2008

Use of corticosteroids in addition to other treatment for children with bacterial meningitis is not associated with a decreased risk of death or shorter hospital stay, according to a study in the May 7 issue of JAMA.

In adults, the use of corticosteroids (synthetic steroids used to reduce inflammation) in addition to primary therapy for bacterial meningitis reduces mortality, although in children the potential benefit of steroids remains unclear, with studies yielding mixed results, according to background information in the article.

Jillian Mongelluzzo, B.A., of the Children’s Hospital of Philadelphia, and colleagues conducted a study to determine the effect of adjuvant (supplemental) corticosteroid therapy on death and length of hospitalization in children with bacterial meningitis. The study included 2,780 children treated for bacterial meningitis, with data from the Pediatric Health Information System, a database containing information from 27 tertiary care children’s hospitals located in 18 U.S. states and the District of Columbia. The median (midpoint) age was 9 months; 57 percent of the patients were males. Streptococcus pneumoniae was the most commonly identified cause of meningitis. Adjuvant corticosteroids were administered to 248 children (8.9 percent).

The overall rate of death was 4.2 percent; the cumulative rates of death were 2.2 percent and 3.1 percent at 7 days and 28 days, respectively, after admission. There were 15 deaths (6.0 percent) in children who received corticosteroids and 102 deaths (4.0 percent) in children who did not receive corticosteroids. Additional analysis indicated the difference in time to death between the two groups was not statistically significant, and that adjuvant corticosteroids were not associated with reducing the risk of death in any age category.

The overall median length of stay was 11 days, with the median length of stay for children who received corticosteroids being 12 days, and the median length of stay for the children who did not receive corticosteroids being 10 days. The unadjusted difference in time to hospital discharge was not statistically significant. Length of hospital stay, analyzed as time to hospital discharge, was not associated with the administration of adjuvant corticosteroids for any age group.

“Our study results of no difference in mortality in children who received or did not receive corticosteroid therapy may differ from results of studies of adults for several reasons. First, adults may have different predisposing factors for meningitis or a different inflammatory response, either of which may alter the course of disease compared with children. Second, the case fatality rate in pneumococcal meningitis in children is lower in comparison with the case fatality rate in adults with pneumococcal meningitis (4.2 percent vs. 34 percent, respectively). Our study could have been underpowered to determine a difference in mortality when case fatality rates are low in children with bacterial meningitis,” the authors write.

“… adjuvant corticosteroid use in the treatment of bacterial meningitis appears to be increasing. A randomized trial is warranted to explore the possible benefit of adjuvant corticosteroid therapy on both morbidity and mortality in children with bacterial meningitis before such corticosteroid use becomes routine,” the researchers conclude.

Source: JAMA and Archives Journals

Explore further: US scientists make embryonic stem cells from adult skin

add to favorites email to friend print save as pdf

Related Stories

Steroids aid recovery from pneumonia, researchers say

Oct 14, 2008

Adding corticosteroids to traditional antimicrobial therapy might help people with pneumonia recover more quickly than with antibiotics alone, UT Southwestern Medical Center scientists have found.

Recommended for you

Leeches help save woman's ear after pit bull mauling

Apr 18, 2014

(HealthDay)—A pit bull attack in July 2013 left a 19-year-old woman with her left ear ripped from her head, leaving an open wound. After preserving the ear, the surgical team started with a reconnection ...

New pain relief targets discovered

Apr 17, 2014

Scientists have identified new pain relief targets that could be used to provide relief from chemotherapy-induced pain. BBSRC-funded researchers at King's College London made the discovery when researching ...

User comments : 0

More news stories

Less-schooled whites lose longevity, study finds

Barbara Gentry slowly shifts her heavy frame out of a chair and uses a walker to move the dozen feet to a chair not far from the pool table at the Buford Senior Center. Her hair is white and a cough sometimes interrupts her ...

How to keep your fitness goals on track

(HealthDay)—The New Year's resolutions many made to get fit have stalled by now. And one expert thinks that's because many people set their goals too high.

Low tolerance for pain? The reason may be in your genes

Researchers may have identified key genes linked to why some people have a higher tolerance for pain than others, according to a study released today that will be presented at the American Academy of Neurology's 66th Annual ...

Growing app industry has developers racing to keep up

Smartphone application developers say they are challenged by the glut of apps as well as the need to update their software to keep up with evolving phone technology, making creative pricing strategies essential to finding ...

Making graphene in your kitchen

Graphene has been touted as a wonder material—the world's thinnest substance, but super-strong. Now scientists say it is so easy to make you could produce some in your kitchen.