Early corticosteroid treatment + antibiotics quickly brings full bacterial meningitis recovery
Treating bacterial meningitis quickly upon diagnosis with both antibiotics and corticosteroids has met with mixed reviews over the years.
A recent case report, however, reports that antibiotics and the corticosteroid dexamethasone—when started early enough—can lead to a full recovery of bacterial meningitis in the shortest time.
The article, titled “Earliest Administration of Dexamethasone in a Case Diagnosed with Bacterial Meningitis Along with Antibiotics Leading to Full Recovery in the Shortest Period” and published in the International Journal of Clinical and Medical Cases, was authored by researchers from Hackensack Meridian Jersey Shore University Medical Center and the Cleveland Clinic.1 Professor of Medicine and Nephrologist Sushil K. Mehandru, MD, led the team.
The Story Unfolds
The case study follows a 70-year-old woman who was prescribed dexamethasone for severe pain in her large joints, with the pain presumed to be a symptom of arthritis.
Key to this case: The corticosteroid was prescribed a full 72 hours before the woman fell into a coma and was brought by ambulance to the hospital. Tests confirmed that the woman had Neisseria meningitis—a leading cause of bacterial meningitis throughout the world.2
“This patient was comatose when admitted to the hospital,” reported Dr. Mehandru and her co-authors. “She continued to be treated with dexamethasone, and antibiotics were initiated. She was discharged from the ICU within 13 hours of admission, awake, alert and fully oriented without any neurological deficits. After long-term follow-up, a year later, the patient showed no residual neurological consequences from the meningitis.”
Based on this case, the authors believe that dexamethasone reduces morbidity and mortality in bacterial meningitis by blunting the inflammatory response secondary to bacterial destruction, which frequently causes detrimental physiological effects.
According to Dr. Mehandru, this case stands apart from previous research that investigated corticosteriods’ effect on bacterial meningitis treatment. “We believe this case represents the earliest use of dexamethasone in bacterial meningitis with dramatic recovery and positive outcome on the short and long term,” Dr. Mehandru wrote. “Although, it is hard to foresee, as in this case, immune mediate oligoarticular arthritis as the prodromal signs of Neisseria Meningitis, this case may make physicians more aware of the possibility. We also recommend Dexamethasone be considered earlier upon suspicion of meningitis much prior to culture and sensitivity reports and much before administration of antibiotics.”
In plainer language, perhaps this study will drive physicians to consider sooner the fact that certain types of arthritis may signal the onset of bacterial meningitis and therefore prescribe dexamethasone before tests even confirm the inflammatory disease.
A Glance Back
The corticosteroid dexamethasone has been linked to bacterial meningitis treatment and recovery for about a decade, with opinions at both extremes.
A 2002 study, published in The New England Journal of Medicine, analyzed two patient groups diagnosed with bacterial meningitis. One group received early treatment with dexamethasone and the second group received a placebo. The study group experienced “significantly” fewer and less severe complications. In addition, the proportion of patients who died was significantly smaller in the dexamethasone group than in the placebo group.3
A 2015 systematic review and meta‐analysis found that dexamethasone did not significantly reduce the death rate in patients with bacterial meningitis. Although, patients treated with corticosteroids did have significantly lower rates of hearing loss and complications involving the central nervous system. While the study did not declare a “significant” degree of benefit from dexamethasone, the meta-analysis authors did find enough evidence to recommend a “four-day regimen of dexamethasone (0.6 mg/kg daily) given before or with the first dose of antibiotics.”4
An updated systematic meta-analysis, published online in 2016, concluded that dexamethasone was not associated with a “significant reduction” in follow-up mortality or severe neurological sequelae. The corticosteroid did, however, seem to reduce hearing loss among survivors.5
Again, a marked difference between these previous analyses and this specific case study comes down to timing. In the case study, dexamethasone was prescribed a full 72 hours before the bacterial meningitis even made itself known. This led the study authors to conclude their case report by stating that “…the early use of dexamethasone may be found beneficial in all types of bacterial meningitis.”
- Mehandru SK, Kaur S, Sen S, Asif A, Vaccharajani T. Earliest Administration of Dexamethasone in a Case Diagnosed With Bacterial Meningitis Along With Antibiotics Leading to Full Recovery in the Shortest Period. Int J Clin Med Cases. 2020 Nov;3(8):165. Available from https://www.boffinaccess.com/clinical-and-medical-cases/earliest-administration-of3-165/IJCMC-3-165.pdf. Accessed on June 29, 2021.
- World Health Organization. Meningococcal meningitis. Available from https://www.who.int/news-room/fact-sheets/detail/meningococcal-meningitis. Accessed on June 29, 2021
- de Gans J, van de Beek D; European Dexamethasone in Adulthood Bacterial Meningitis Study Investigators. Dexamethasone in adults with bacterial meningitis. N Engl J Med. 2002 Nov 14;347(20):1549-56. doi: 10.1056/NEJMoa021334. PMID: 12432041. Available from https://pubmed.ncbi.nlm.nih.gov/12432041/. Accessed on June 29, 2021.
- Brouwer MC, McIntyre P, Prasad K, van de Beek D. Corticosteroids for acute bacterial meningitis. Cochrane Database Syst Rev. 2015;2015(9):CD004405. Published 2015 Sep 12. doi:10.1002/14651858.CD004405.pub5 Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6491272/. Accessed on June 29, 2021
- Shao M, Xu P, Liu J, Liu W, Wu X. The role of adjunctive dexamethasone in the treatment of bacterial meningitis: an updated systematic meta-analysis. Patient Prefer Adherence. 2016;10:1243-1249. Published 2016 Jul 14. doi:10.2147/PPA.S109720. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4951054/. Accessed on June 29, 2021.