Science Links Japan | Influence of Dexamethasone on the Clinical Course of Bacterial Meningitis in Children, Especially on Secondary Fever. Experiences in 27 Institutions.

Influence of Dexamethasone on the Clinical Course of Bacterial Meningitis in Children, Especially on Secondary Fever. Experiences in 27 Institutions.

Accession number;99A0762320

Title;Influence of Dexamethasone on the Clinical Course of Bacterial Meningitis in Children, Especially on Secondary Fever. Experiences in 27 Institutions.

Author;KOBAYASHI YUTAKA(Kobe City Coll. of Nurs.) SUNAKAWA KEISUKE(Kitasato Univ.) FUJITA KOZO(Asahikawa Med. Coll.) SAKATA HIROSHI(Asahikawa Kosei Hosp.) IN'YAKU FUMIE(Furano Kyokai Hosp.) TOYONAGA YOSHIKIYO(Yamanashi Red Cross Hosp.) IWATA SATOSHI(Kasumigaura National Hospital) MEGURO HIDENORI(Teikyo Univ.) FUJII RYOUCHI(Boshikagakuryohoken)

Journal Title;Journal of the Japanese Association for Infectious Diseases

Journal Code:Z0760A

ISSN:0387-5911

VOL.73;NO.7;PAGE.664-674(1999)

Figure&Table&Reference;TBL.9, REF.23

Pub. Country;Japan

Language;Japanese

Abstract;Of pediatric patients with purulent meningitis seen at the institutions listed in the title page of this paper between 1986 and 1994, 93 patients treated with antibiotics and dexamethasone(DXM) were compared with 91 patients treated with antibiotics alone. The patients receiving antibiotics with dexamethasone achieved overall improvement in inflammatory symptoms and signs and cerebrospinal fluid findings and became afebrile significantly earlier than those receiving antibiotics alone. However, some of the patients became febrile again. The secondary fever rate for the DXM group was much higher than that for the antibiotic alone group (p<0.0001). In most of the rebounded cases, the body temperature rose above 38.DEG.C. and remained elevated for 2-4 days. Cerebrospinal fluid(CSF) was cultured daily in 54 and 32 patients receiving antibiotics with and without DXM, respectively. Although this study was not a controlled study in a strict sense, these patients compared. In both groups, the CSF became mostly culture-negative within 48 hours. In a few patients receiving DXM, however, it became culture-negative after 72 hours or longer. DXM caused an adverse effect in a patient with meningitis caused by Streptococcus pneumoniae.The adverse effect was mild gastrointestinal bleeding, which recovered spontaneously. From the findings described above, the use of DXM combined with antibiotic therapy was considered to accelerate the relief from fever and improvement of inflammatory symptoms and signs and CSF findings. The body temperature rose again in more than half of the patients receiving DXM, but fell to normal spontaneously without treatment. The elevation doubtlessly could not be distinguished from recurrence of the meningitis itself or complications. It seems to be likely that no treatment but careful observation is required even if the fever recurs as far as the CSF findings showed favorable progress with excelluent general conditions....(author abst.) (author abst.)