Adjuvant corticosteroid therapy did not improve survival or shorten hospitalization in the largest observational study of its kind ever conducted in children, researchers reported.
These findings held true across all pediatric age groups and regardless of whether the infecting organism was pneumococcal or meningococcal, according to Jillian Mongelluzzo of the division of infectious diseases, Children's Hospital of Philadelphia, and her associates.
Adjuvant corticosteroid therapy does reduce hearing loss in children with meningitis caused by Haemophilus influenzae type b (Hib), but since the widespread use of vaccines against Hib in 1985 and Streptococcus pneumoniae in 2000, the epidemiology of bacterial meningitis has changed dramatically, they said.
Nonetheless, the use of adjuvant corticosteroid therapy appears to be increasing, so “a randomized trial is warranted to explore the possible benefit … before such corticosteroid use becomes routine,” the investigators noted (JAMA 2008;299:2048–55).
In this retrospective cohort study, the investigators used data from the Pediatric Health Information System, a database that covers 27 tertiary care children's hospitals across the country, to track meningitis trends from 2001 through 2006 in areas where Hib meningitis is no longer prevalent.
In all, 2,780 cases of bacterial meningitis in children younger than 18 years were assessed.
Adjuvant corticosteroids, most often dexamethasone, were given to 248 children (9%). The use of these agents increased steadily over time, from 5.8% of patients in 2001 to 12.2% in 2006.
Use varied greatly by hospital, with some centers never giving adjuvant corticosteroids and one giving them in 37% of cases, Ms. Mongelluzzo and her associates said.
There were 15 deaths among children who received corticosteroids (6% mortality) and 102 among the 2,532 children who did not (4% mortality), a difference that was not statistically significant.
The treatment did not improve survival when the data were analyzed by age group, nor did it affect the length of the interval between admission and death, Dr. Mongelluzzo and her associates said.
The median length of stay for children who received corticosteroids was 12 days (range 7–21 days), while the median for children who did not receive corticosteroids was 10 days (range 6–20 days)—a difference that also was not statistically significant.
Length of stay is important to consider because “longer hospitalizations increase the risk of hospital-acquired complications,” the investigators said.
These results did not change when the data were analyzed by type of infecting organism, including Hib, S. pneumoniae, and Neisseria meningitidis, and others.
It is not yet clear why corticosteroids do not improve survival in children as they do in adults.
Adults may have different predisposing factors for meningitis or a different inflammatory response, which could change their course of disease in comparison with children, Ms. Mongelluzzo and her associates noted.
They added that this study did not address the possible benefits of adjuvant corticosteroid therapy on hearing loss or neurologic morbidity in children.