Corticosteroid Administration and Outcome of Adolescents and Adults With Acute Bacterial Meningitis: A Meta-analysis

• Published in: Mayo Clinic proceedings 2009, Vol.84 (5), p.403-409
• Main Authors: Assiri, Abdullah M., MD, Alasmari, Faisal A., MBBS, Zimmerman, Valerie A., PhD, Baddour, Larry M., MD, Erwin, Patricia J., MLS, Tleyjeh, Imad M., MD, MSc
• Format: Article
• Language: English
• Subjects: Internal Medicine
• ISSN: 0025-6196
• DOI: 10.4065/84.5.403

OBJECTIVE To systematically assess the effect of the adjunctive administration of corticosteroids in the treatment of acute bacterial meningitis. METHODS We performed a systematic review and meta-analysis by searching several databases for reports (published from January 1966 through February 2008) of placebo-controlled randomized trials of corticosteroid use in the treatment of adolescents and adults with acute bacterial meningitis. We used random-effects models. Sources of heterogeneity were explored by preplanned subgroup analyses. RESULTS The 4 eligible trials (published between 1999 and 2007) were of high methodological quality and included 1261 adult patients. Overall, the short-term mortality rate associated with corticosteroid administration was not significantly lower than that associated with placebo (relative risk [RR], 0.81; 95% confidence interval [CI], 0.54-1.20; I2 =54%). A significant interaction was found between the effect of corticosteroids and the income status of the country ( P =.02) and the prevalence of infection with human immunodeficiency virus (HIV) among study populations ( P =.03). The administration of corticosteroids resulted in a lower short-term mortality rate than did the administration of placebo in high-income countries (pooled RR, 0.5; 95% CI, 0.27-0.92; I2 =0%) and in the studies with a low prevalence of infection with HIV (RR, 0.66; 95% CI, 0.44-0.99; I2 =0%). In studies from high-income countries, the number needed to treat with corticosteriods to prevent 1 death and 1 neurologic sequela was 12.5 (95% CI, 7.1-100.0) and 11.0 (95% CI, 5.6-100.0), respectively. CONCLUSION Our meta-analysis suggests that the adjunctive administration of corticosteroids is beneficial in the treatment of adolescents and adults with bacterial meningitis in patient populations similar to those seen in high-income countries and in areas with a low prevalence of HIV infection.