Corticosteroids help prevent hearing loss, neurologic sequelae in paediatric bacterial meningitis

Children with bacterial meningitis appear to fare well with corticosteroids, which lead to a lower incidence of hearing loss and neurologic sequelae and faster resolution of fever, according to a meta-analysis.

Researchers searched multiple online databases for randomized clinical trials that evaluated corticosteroids as adjuvant therapy in paediatric bacterial meningitis. The primary outcomes were hearing loss and neurologic sequelae, while secondary outcomes included mean days before resolution of fever, mortality, secondary fever, and reactive arthritis.

A total of 29 studies involving 3,433 patients were included in the meta-analysis. Pooled data, obtained using fixed- and random-effects models, showed that treatment with corticosteroids was associated with a lower risk of hearing loss (risk ratio [RR], 0.62, 95 percent confidence interval [CI], 0.47–0.81; I², 17 percent; p=0.0006).

There was no benefit found for neurologic sequelae overall. However, subgroup analysis revealed that low-dose corticosteroids (0.6 mg/kg per day) conferred a significant protection against the outcome (RR, 0.60, 95 percent CI, 0.47–0.77; I², 0 percent; p<0.0001) but not high doses (0.8 mg/kg per day).

An increasing rate of secondary fever was found among patients treated with corticosteroids (RR, 1.29, 95 percent CI, 1.10–1.51; I², 13 percent; p=0.001). Nevertheless, corticosteroids led to a significant reduction in the mean days before resolution of fever (mean difference, −1.48, 95 percent CI, −1.79 to −1.17; I², 84 percent; p<0.00001).

Corticosteroids showed no association with the rate of mortality and reactive arthritis.