Steroids Provide No Survival Benefit for Children With Bacterial Meningitis
-Large Study Shows Benefits Differ from those in Adults-
PHILADELPHIA, May 6 /PRNewswire-USNewswire/ -- Corticosteroids
given to children who are hospitalized for bacterial meningitis do
not provide a benefit in survival or in reduced hospital stays,
according to a large multicenter study by pediatric researchers.
This finding stands in contrast to previous studies in hospitalized
adults, for whom corticosteroids dramatically reduced
mortality.
"Because of the demonstrated benefits of these drugs in adults,
physicians have increasingly been using corticosteroids in children
with bacterial meningitis," said study leader Samir S. Shah, M.D.,
an infectious diseases specialist from The Children's Hospital of
Philadelphia. "This study reminds us again that children are not
just small adults. We need to consider whether the problems
associated with corticosteroid use, such as gastrointestinal
bleeding, outweigh any potential benefits."
He added that further research should analyze whether
corticosteroids may provide other benefits to children, such as
improved neurological outcomes among survivors, a question not
considered in this study.
The study appears in the May 7 issue of the Journal of the
American Medical Association.
Shah's team analyzed medical records of 2,780 children with
bacterial meningitis at 27 U.S. pediatric hospitals from 2001 to
2006. The median age of the children was nine months. Approximately
9 percent, or 248, of the children studied received
corticosteroids, with steroid use doubling during the study period,
from under 6 percent of children in 2001 to 12 percent in
2006.
There was no significant difference in mortality nor in time to
hospital discharge, between children who received corticosteroids
and those who did not. Overall, unadjusted mortality rates were 6
percent among children receiving corticosteroids, versus 4 percent
among those not receiving them. There also was no significant
difference in those outcomes between those receiving and not
receiving corticosteroids in the subsets of children with
meningitis caused by pneumococcal bacteria or by meningococcal
bacteria.
Meningitis is an inflammation of the meninges, the membrane
lining the brain. The bacterial form is relatively rare in
children, with an incidence of about eight in 100,000 in the U.S.
However, bacterial meningitis is potentially life-threatening, and
requires hospitalization and treatment with antibiotics. Several
different varieties of bacteria may cause meningitis, although the
patterns have changed with the introduction of vaccines.
Previous studies had shown that corticosteroids had a clear
benefit in preventing hearing loss in children whose meningitis was
caused by Hemophilus influenzae type b (Hib) bacteria. However,
since the Hib vaccine was approved for routine use in childhood
immunizations in 1985, cases of Hib meningitis have dropped sharply
in the United States. Now bacterial meningitis in children is more
commonly caused by pneumococcal or meningococcal
bacteria.
Further studies may reveal that corticosteroids may also reduce
hearing loss or other neurologic injuries in children with
bacterial meningitis not caused by Hib, said Shah, but there is
currently no such evidence. He added, "Our study shows the need for
a further study in children -- a large randomized clinical trial to
examine all outcomes of steroid use, before the use of these
medicines becomes routine in children with bacterial
meningitis."
The National Center for Research Resources, part of the National
Institutes of Health, supported the study, along with the Agency
for Healthcare Research and Quality. One co-author, Jillian
Mongelluzzo, received support from the Doris Duke Medical Student
Clinical Research Fellowship. Shah's other co-authors were Zeinab
Mohamad, M.S., from Children's Hospital, and Thomas R. Ten Have,
Ph.D., from the University of Pennsylvania School of
Medicine.
About The Children's Hospital of Philadelphia: The Children's
Hospital of Philadelphia was founded in 1855 as the nation's first
pediatric hospital. Through its long-standing commitment to
providing exceptional patient care, training new generations of
pediatric healthcare professionals and pioneering major research
initiatives, Children's Hospital has fostered many discoveries that
have benefited children worldwide. Its pediatric research program
is among the largest in the country, ranking third in National
Institutes of Health funding. In addition, its unique
family-centered care and public service programs have brought the
430-bed hospital recognition as a leading advocate for children and
adolescents. For more information, visit http://www.chop.edu/.
Contact: Rachel Salis-Silverman Phone: (267) 426-6063 Salis@email.chop.edu
Source: The Children's Hospital of Philadelphia
CONTACT: Rachel Salis-Silverman of The Children's Hospital
of
Philadelphia, +1-267-426-6063, Salis@email.chop.edu
Web Site: http://www.chop.edu/
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