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Association of Corticosteroid Treatment With Outcomes in Pediatric Patients With Bacterial Meningitis: A Systematic Review and Meta-analysis of Randomized Controlled Trials

  • Chao Tian
    Affiliations
    School of Pharmaceutical Sciences, Capital Medical University, Beijing, China

    Department of Pharmacy, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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  • Siyao Jin
    Affiliations
    School of Pharmaceutical Sciences, Capital Medical University, Beijing, China
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  • Zinan Zhao
    Affiliations
    Department of Pharmaceutical Science, Beijing Hospital, Beijing, China

    National Center of Gerontology, Beijing, China

    Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing, China

    Beijing Key Laboratory of Drug Clinical Risk and Personalized Medication Evaluation, Beijing, China
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  • Xiaohui Liu
    Affiliations
    Department of Pharmacy, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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  • Haixin Cheng
    Affiliations
    Department of Pharmacy, Capital Institute of Pediatrics, Beijing, China
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  • Author Footnotes
    ⁎ These authors contributed equally to this work.
    Xiaoling Wang
    Correspondence
    Address correspondence to: Xiaoling Wang, MS, or Libo Zhao, PhD, Department of Pharmacy, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China.
    Footnotes
    ⁎ These authors contributed equally to this work.
    Affiliations
    Department of Pharmacy, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
    Search for articles by this author
  • Author Footnotes
    ⁎ These authors contributed equally to this work.
    Libo Zhao
    Correspondence
    Address correspondence to: Xiaoling Wang, MS, or Libo Zhao, PhD, Department of Pharmacy, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China.
    Footnotes
    ⁎ These authors contributed equally to this work.
    Affiliations
    Department of Pharmacy, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
    Search for articles by this author
  • Author Footnotes
    ⁎ These authors contributed equally to this work.

      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;  = 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;  = 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;  = 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;  = 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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