Abstract
Purpose
Controversy has arisen among the overall benefit and potential risks in the use of
corticosteroids for the treatment of pediatric bacterial meningitis. This systematic
review and meta-analysis aims to provide evidence of the use of corticosteroids in
the treatment of bacterial meningitis in children.
Methods
Electronic databases (PubMed, Embase, Cochrane Central Register of Controlled Trials,
and other databases) were searched from inception until March 9, 2021. Randomized
clinical trials focused on corticosteroids as adjuvant therapy in pediatric bacterial
meningitis were considered eligible. The primary outcomes were hearing loss and neurologic
sequelae. Secondary outcomes were mean days before resolution of fever, mortality,
secondary fever, and reactive arthritis. Fixed- or random-effects models were used
to evaluate the association between corticosteroids therapy and outcomes by calculating
risk ratios (RRs) and mean differences (MDs) with corresponding 95% CIs. Two independent
reviewers completed citation screening, data extraction, and risk assessment.
Findings
Twenty-nine studies with 3433 patients were included. An obvious benefit was found
in the treatment of corticosteroids in hearing loss (RR = 0.62; 95% CI, 0.47–0.81;
I² = 17%; P = 0.0006). No benefit was found in the rate of neurologic sequelae. However, obvious
benefit was found in the low-dosage subgroup (0.6 mg/kg per day) (RR = 0.60; 95% CI,
0.47–0.77; I² = 0%; P < 0.0001) but not in the high-dosage subgroup (0.8 mg/kg per day). An increasing
rate of secondary fever was found when using corticosteroids (RR = 1.29; 95% CI, 1.10–1.51;
I² = 13%; P = 0.001). Corticosteroids could significantly decrease the mean days before resolution
of fever (MD = −1.48; 95% CI, −1.79 to −1.17; I² = 84%, P < 0.00001). No difference was found in the rate of mortality and reactive arthritis.
Implications
The findings of this study suggest that the administration of corticosteroids is associated
with reduced hearing loss and neurologic sequelae especially in children using a low
dose of corticosteroids. Benefits also included a reduction in the mean number of
days before resolution of fever.
Key words
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Article info
Publication history
Published online: March 08, 2022
Accepted:
February 13,
2022
Footnotes
Accepted for publication February 13, 2022.
Identification
Copyright
© 2022 Elsevier Inc.
