Steroids don't help children with meningitis

NEW YORK (Reuters Health) - Although add-on treatment with corticosteroids lowers the chances that adults with bacterial meningitis will die, it has no similar benefit for children with the disease, according to a new report.

Bacterial meningitis is an infection of the lining of the brain, and corticosteroids potently suppress inflammation. After several studies showed reduced mortality among adults with bacterial meningitis who were given corticosteroids, more doctors started using them routinely for children "or were asking us whether or not corticosteroids should be used to treat children suspected of having bacterial meningitis," Dr. Samir S. Shah told Reuters Health.

"We reviewed the pediatric data and found no clear answer," he said.

Shah, at the University of Pennsylvania School of Medicine and The Children's Hospital of Philadelphia, explained that there are two main concerns with using corticosteroids to treat bacterial meningitis in children.

By reducing brain inflammation, he continued, corticosteroids may substantially impair the ability of antibiotics to cross the blood-brain barrier to get to the site of the infection, resulting in higher rates of antibiotic failure.

"Second," he added, "corticosteroid use may prevent or mask the fever that may be an early sign of antibiotic failure."

Shah's group conducted a study involving 2780 young children treated for bacterial meningitis at 27 children's hospitals in the US.

A total of 248 (8.9 percent) received intravenous corticosteroids on the first day of hospitalization, according to the report in this week's Journal of the American Medical Association.

Mortality rates in children who were and were not treated with corticosteroids were 6 percent and 4 percent, respectively -- not a statistically significant difference.

In adults, the benefits of corticosteroid therapy seem to outweigh the risks, Shah concluded. "In children, the same does not appear to be true."

SOURCE: Journal of the American Medical Association, May 7, 2008.