Despite advances in antimicrobial treatment of bacterial meningitis in children, morbidity and mortality are substantial. Adjuvant dexamethasone is currently recommended for children with meningitis due to Haemophilus influenzae type b to improve outcome; recommendations for use of dexamethasone in children with meningitis due to Streptococcus pneumoniae are controversial. Conclusions regarding dexamethasone use for children with pneumococcal meningitis are derived from existing meta-analyses, which are confounded by the inclusion of studies with small numbers, substantial economic variability, and poor design. In contrast, circumstantial data derived from adult studies of pneumococcal meningitis are compelling in demonstrating effectiveness of dexamethasone in improving mortality and neurologic outcomes. Barring known differences in the inflammatory response stimulated by S pneumoniae according to age or the impact of steroids on inflammation according to age, this review endorses dexamethasone for children with pneumococcal meningitis.
Ellen R. Wald (Fri,) studied this question.