Association of Corticosteroid Treatment With Outcomes in Pediatric Patients With Bacterial Meningitis: A Systematic Review and Meta-analysis of Randomized Controlled Trials

• Published in: Clinical therapeutics 2022-04, Vol.44 (4), p.551-564
• Main Authors: Tian, Chao, Jin, Siyao, Zhao, Zinan, Liu, Xiaohui, Cheng, Haixin, Wang, Xiaoling, Zhao, Libo
• Format: Article
• Language: English
• Subjects: Adrenal Cortex Hormones - adverse effects; Arthritis; Arthritis, Reactive - complications; Arthritis, Reactive - drug therapy; Bacteria; bacterial meningitis; Bias; Child; Children; Clinical trials; Collaboration; Corticoids; corticosteroid; Corticosteroids; Dosage; Fever; Hearing; Hearing loss; Hearing Loss - chemically induced; Hearing Loss - diagnosis; Hearing Loss - drug therapy; Humans; Immunomodulators; Meningitis; Meningitis, Bacterial - complications; Meningitis, Bacterial - drug therapy; Meta-analysis; Mortality; Neurological complications; Patients; Pediatrics; randomized clinical trial; Randomized Controlled Trials as Topic; Risk assessment; Sensitivity analysis; Steroids; subgroup analysis; Subgroups; Systematic review
• ISSN: 0149-2918; 1879-114X
• DOI: 10.1016/j.clinthera.2022.02.008

Controversy has arisen among the overall benefit and potential risks in the use of corticosteroids for the treatment of pediatric bacterial meningitis. This systematic review and meta-analysis aims to provide evidence of the use of corticosteroids in the treatment of bacterial meningitis in children. Electronic databases (PubMed, Embase, Cochrane Central Register of Controlled Trials, and other databases) were searched from inception until March 9, 2021. Randomized clinical trials focused on corticosteroids as adjuvant therapy in pediatric bacterial meningitis were considered eligible. The primary outcomes were hearing loss and neurologic sequelae. Secondary outcomes were mean days before resolution of fever, mortality, secondary fever, and reactive arthritis. Fixed- or random-effects models were used to evaluate the association between corticosteroids therapy and outcomes by calculating risk ratios (RRs) and mean differences (MDs) with corresponding 95% CIs. Two independent reviewers completed citation screening, data extraction, and risk assessment. Twenty-nine studies with 3433 patients were included. An obvious benefit was found in the treatment of corticosteroids in hearing loss (RR = 0.62; 95% CI, 0.47–0.81; I² = 17%; P = 0.0006). No benefit was found in the rate of neurologic sequelae. However, obvious benefit was found in the low-dosage subgroup (0.6 mg/kg per day) (RR = 0.60; 95% CI, 0.47–0.77; I² = 0%; P < 0.0001) but not in the high-dosage subgroup (0.8 mg/kg per day). An increasing rate of secondary fever was found when using corticosteroids (RR = 1.29; 95% CI, 1.10–1.51; I² = 13%; P = 0.001). Corticosteroids could significantly decrease the mean days before resolution of fever (MD = −1.48; 95% CI, −1.79 to −1.17; I² = 84%, P < 0.00001). No difference was found in the rate of mortality and reactive arthritis. The findings of this study suggest that the administration of corticosteroids is associated with reduced hearing loss and neurologic sequelae especially in children using a low dose of corticosteroids. Benefits also included a reduction in the mean number of days before resolution of fever.