The role of corticosteroid therapy in children with pneumococcal meningitis

Article Abstract:

Pneumococci are a group of bacteria that are protected by an outer capsule. They can cause pneumonia and other serious infections. About 10 percent of cases of meningitis are caused by pneumococcal bacteria. About 10 percent of patients with pneumococcal meningitis die, while up to 30 percent are seriously affected. These rates have changed little, despite the availability of strong antibiotics that are active in infected meningeal tissues (membranes covering the brain and spinal cord). Experimental results suggest that a significant portion of pneumococcal meningitis symptoms are caused by the reactivity of immune cells to antibiotic-induced release of fragments from the bacterial capsule; this reactivity may result in inflammatory reactions involving human tissue. Steroids can suppress the activity of immune cells, and previous studies have suggested that steroid therapy may benefit children with pneumococcal meningitis. The current study reviewed the outcomes of 97 infants and children with the pneumococcal meningitis, 41 of whom were treated with steroids as well as antibiotics. The total duration of fever was significantly less in patients who were given steroids, and glucose levels in cerebrospinal fluid (CSF, the fluid that bathes the brain and spinal cord) were significantly higher in these children. Cerebrovascular instability, indicated by signs of sepsis (systemic infection), shock, or seizures, developed more often in children who received only antibiotics or were given steroids after antibiotic treatment. Likewise, cerebrovascular instability occurred less frequently in children who received steroids and antibiotics simultaneously and those who received steroids before antibiotic therapy. The death rates in the two groups were similar, but mortality was significantly higher in those who developed cerebrovascular instability. Steroid-treated patients less frequently developed overwhelming meningeal infection, which was associated with high mortality, seizures, and hearing loss. Subsequently, children who received steroids had a significantly lower rate of neurologic dysfunction and hearing loss. The report suggests that steroids, administered with antibiotics, improve the prognosis of children with pneumococcal meningitis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Corticosteroids, Streptococcus pneumoniae

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Corticosteroids as adjunctive therapy in bacterial meningitis; a meta-analysis of clinical trials

Article Abstract:

Meningitis is any infection or swelling of the membranes covering the brain or spinal cord. Meningitis caused by bacteria can be potentially life-threatening. Although antibiotic therapy has prevented many deaths from bacterial meningitis, the mortality rate is still between one and eight percent. The rate of severe neurological damage is 10 to 30 percent, and hearing loss occurs in five to 31 percent. The use of corticosteroids to reduce swelling is controversial, as reports of their effects contain conflicting results. Some reports indicate that corticosteroids such as dexamethasone can either reduce hearing loss, have no benefit at all, or be harmful. A review of all nine drug trials over the past 31 years of corticosteroid therapy for acute bacterial meningitis is presented. Corticosteroid therapy did not reduce the death rate or neurological complications produced by bacterial meningitis. It did reduce the risk of moderate to severe hearing loss following meningitis infections. However, this may only be true for children infected with the hemophilus influenzae bacteria. Corticosteroid drugs may actually prevent antibiotics from penetrating the membrane to reach the bacteria infecting spinal fluid. In addition, superinfections and bleeding from the stomach and intestines have also been reported with corticosteroid use. Therefore, corticosteroid therapy in the treatment of bacterial meningitis offered no improvement with respect to mortality and neurological abnormalities. The routine use of corticosteroid therapy when treating acute bacterial meningitis is not currently supported. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Dexamethasone, Anti-inflammatory drugs, Anti-inflammatory agents

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Surfactant replacement therapy in respiratory distress syndrome: meta-analysis of clinical trials of single-dose surfactant extracts

Article Abstract:

A major cause of illness and death in newborns is respiratory distress syndrome (RDS), a condition characterized by airless lung sacs or alveoli, inelastic lungs, rapid respiration, flaring of the nostrils and grunting on expiration. There is evidence that the primary underlying cause of this syndrome is a deficiency of lung surfactant. Surfactants are lipoproteins that reduce the surface tension of lung fluids and allow the exchange of gases in the lung and contribute to the elasticity of lung tissue. There have been many studies performed regarding replacement therapy with surfactant extracts, but small sample sizes in these studies did not permit definitive conclusions. Meta-analysis is a statistical method for bringing scientific rigor to the job of drawing conclusions from the results of a large number of small size trials dealing with a closely related clinical issue. Meta-analysis was applied to seven clinical trials that used a single dose of non-human surfactant extract to determine the effect of treatment on morbidity and mortality. In the combined trials there were 277 patients treated and 263 controls. Meta-analysis showed that a single dose of surfactant given to a baby with RSD within 15 minutes of birth significantly decreased both mortality and the risk of developing pneumothorax (collapsed lung). Further study is needed to evaluate other aspects of surfactant therapy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Diseases, Infants (Newborn), Neonatal diseases, Respiratory distress syndrome, Pediatric respiratory diseases, Pulmonary surfactant, Pulmonary surfactants

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