1. Contact: Jaida Butler
T: (44) 01243 770674
E: jbutler@wiley.co.uk
For Immediate Release
Change policy: Giving steroids to children with meningitis
can reduce hearing loss and lower the incidence of long-term
brain damage and can save lives in both children and adults
with meningitis
Research News in the Cochrane Database of Systematic
Reviews
Antibiotics are essential and life-saving in the treatment of bacterial meningitis, but
for years doctors have debated whether to give corticosteroids at the same time. The
inflammation caused by meningitis can actually be made worse by antibiotics in the
short term, as the bacteria killed by antibiotics release various toxins. Experimental
evidence showed that steroids reduce this inflammation, which carries with it the risk
of permanent brain damage and/or deafness from impaired blood supply.
Many controlled trials in humans have looked at the effect of adding corticosteroid
therapy to antibiotics in acute bacterial meningitis, but each trial on its own has not
given conclusive results.
A review published in the July update of the Cochrane Database of Systematic
Reviews settles the argument. Giving corticosteroids with antibiotics more than
halves the number of children who suffer from severe hearing loss – a reduction from
8% to 3%. The effect on reducing deaths and brain damage was less dramatic, but
even so, in both cases children benefited from using the two drugs together.
For adults with bacterial meningitis, giving corticosteroids would save one life for
every 10 patients treated – a reduction from 18 to 8%.
“Our analysis of currently available data shows that there is strong evidence for
giving corticosteroids to children suspected of having bacterial meningitis”, says lead
author, Dr Diederik van de Beek of the Department of Neurology at the Academic
Medical Center University of Amsterdam.
This authoritative review was compiled with the help of an international team
involving Dr Jan de Gans from the Netherlands, Prof Peter McIntyre from Australia,
and Prof Kameshwar Prasad from India.
They recommend that, in developed countries, patients are given a four-day course of
dexamethasone (0.6mg/kg daily). As it is important to give the first steroid dose
before, or at least with, the first dose of intravenous antibiotics in hospital, use of

2. dexamethasone is less applicable in countries where there is likely to be a significant
delay before hospital treatment.
Notes for Editors
1. van de Beek D, de Gans J, McIntyre P, Prasad K Corticosteroids in acute
bacterial meningitis (Cochrane Review). In: The Cochrane Library, Issue 3,
2003
2. The Cochrane Collaboration started in 1992. Its headquarters are in Oxford,
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healthcare policymakers at medical institutions, universities, corporations, and
healthcare organizations around the world, including the UK’s National Health
Service. The Collaboration encompasses an established network of 50
research groups worldwide that prepare and maintain Cochrane reviews,
covering a range of medical specialties. Approximately 10,000 people are
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4. For further information about the review, please contact Jaida Butler on 01243
770674 or jbutler@wiley.co.uk