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Current Opinion: Indications for Initiating Dexamethasone Therapy in Children With Meningitis in the Emergency Department

Current Opinion: Indications for Initiating Dexamethasone Therapy in Children With Meningitis in... Abstract Sir.—A 1991 study showed that adjunctive dexamethasone therapy significantly reduced the rate of neurologic sequelae experienced by children with bacterial meningitis.1 The most recent (1991) recommendation by the American Academy of Pediatrics Committee on Infectious Diseases2 was that "dexamethasone therapy be considered only when the diagnosis of bacterial meningitis has been proven or is strongly suspected on the basis of the CSF [cerebrospinal fluid] examination, Gram-stained smear, or antigen test results", and that "dexamethasone should not be used for suspected or proven aseptic or non-bacterial meningitis." The protocol includes initiating dexamethasone prior to administering the initial dose of antibiotics so as to diminish the host inflammatory response to rapid lysis of a large inoculum of bacteria. In most cases, these recommendations place the burden of deciding whether to initiate dexamethasone therapy for suspected bacterial meningitis on the emergency medicine physician, since lumbar puncture is performed and the References 1. Odio C, Faingezicht I, Paris M, McCracken GH. The beneficial effects of dexamethasone therapy for bacterial meningitis . N Engl J Med. 1991;324:1525.Crossref 2. The Committee on Infectious Diseases. Dexamethasone Therapy for Bacterial Meningitis in Infants and Children . 2nd ed. Elk Grove Village, Ill: American Academy of Pediatrics; 1991:566-570. 3. Bonadio WA, Bruce R, Barry D, Smith D. Reference values of non-infected cerebrospinal fluid in infants aged 0-8 weeks . Pediatr Infect Dis J. 1992;11:589-591.Crossref 4. Portnoy J, Olson L. Normal cerebrospinal fluid values in children: another look . Pediatrics . 1985;75:484. 5. Sarff L, Platt L, McCracken GH. Cerebrospinal fluid evaluation in neonates: comparison of high-risk infants with and without meningitis . J Pediatr. 1976;88:473-476.Crossref 6. Bonadio WA. The cerebrospinal fluid: physiologic aspects and alterations with bacterial meningitis . Pediatr Infect Dis J 1992;11:423-432.Crossref 7. Izsak I. Pediatric emergency medicine fellowship programs . Pediatr Emerg Care . 1990;6:68.Crossref 8. Waagner DC, Kennedy W, Hoyt M. Lack of adverse effects of dexamethasone therapy in aseptic meningitis . Pediatr Infect Dis J. 1990;9:922. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Diseases of Children American Medical Association

Current Opinion: Indications for Initiating Dexamethasone Therapy in Children With Meningitis in the Emergency Department

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References (10)

Publisher
American Medical Association
Copyright
Copyright © 1993 American Medical Association. All Rights Reserved.
ISSN
0002-922X
DOI
10.1001/archpedi.1993.02160260021010
Publisher site
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Abstract

Abstract Sir.—A 1991 study showed that adjunctive dexamethasone therapy significantly reduced the rate of neurologic sequelae experienced by children with bacterial meningitis.1 The most recent (1991) recommendation by the American Academy of Pediatrics Committee on Infectious Diseases2 was that "dexamethasone therapy be considered only when the diagnosis of bacterial meningitis has been proven or is strongly suspected on the basis of the CSF [cerebrospinal fluid] examination, Gram-stained smear, or antigen test results", and that "dexamethasone should not be used for suspected or proven aseptic or non-bacterial meningitis." The protocol includes initiating dexamethasone prior to administering the initial dose of antibiotics so as to diminish the host inflammatory response to rapid lysis of a large inoculum of bacteria. In most cases, these recommendations place the burden of deciding whether to initiate dexamethasone therapy for suspected bacterial meningitis on the emergency medicine physician, since lumbar puncture is performed and the References 1. Odio C, Faingezicht I, Paris M, McCracken GH. The beneficial effects of dexamethasone therapy for bacterial meningitis . N Engl J Med. 1991;324:1525.Crossref 2. The Committee on Infectious Diseases. Dexamethasone Therapy for Bacterial Meningitis in Infants and Children . 2nd ed. Elk Grove Village, Ill: American Academy of Pediatrics; 1991:566-570. 3. Bonadio WA, Bruce R, Barry D, Smith D. Reference values of non-infected cerebrospinal fluid in infants aged 0-8 weeks . Pediatr Infect Dis J. 1992;11:589-591.Crossref 4. Portnoy J, Olson L. Normal cerebrospinal fluid values in children: another look . Pediatrics . 1985;75:484. 5. Sarff L, Platt L, McCracken GH. Cerebrospinal fluid evaluation in neonates: comparison of high-risk infants with and without meningitis . J Pediatr. 1976;88:473-476.Crossref 6. Bonadio WA. The cerebrospinal fluid: physiologic aspects and alterations with bacterial meningitis . Pediatr Infect Dis J 1992;11:423-432.Crossref 7. Izsak I. Pediatric emergency medicine fellowship programs . Pediatr Emerg Care . 1990;6:68.Crossref 8. Waagner DC, Kennedy W, Hoyt M. Lack of adverse effects of dexamethasone therapy in aseptic meningitis . Pediatr Infect Dis J. 1990;9:922.

Journal

American Journal of Diseases of Children – American Medical Association

Published: Feb 1, 1993

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