Dexamethasone Cuts Death Risk in Paediatric Meningitis

TOPLINE: 

Compared with no dexamethasone treatment, early administration of dexamethasone in children with pneumococcal meningitis lowered 30-day all-cause mortality by 50%, a new study showed.

METHODOLOGY:

• Researchers conducted a non-randomised, comparative, multicentre, retrospective, quasi-experimental, propensity score–based study using data from a French national surveillance system between 2005 and 2022.
• Analysis included 1231 children aged 0-17 years (median age, 1.1 years; 40% girls) with confirmed pneumococcal meningitis.
• Participants received either dexamethasone (0.15 mg/kg every 6 hours for 4 days), starting within 12 hours of antibiotic treatment (n = 650), or no dexamethasone (n = 581).
• The primary outcome was 30-day all-cause mortality after hospital admission, and the secondary outcomes were hearing loss and acute neurological complications during hospitalisation.

TAKEAWAY:

• Overall mortality was 9%, with 97.2% of deaths occurring within 30 days of hospitalisation.
• The adjusted 30-day death rate was 6% in the dexamethasone group vs 12% in the no dexamethasone group (marginal odds ratio, 0.39; 95% CI, 0.23-0.65).
• The use of dexamethasone was not associated with acute neurological complications or hearing loss during hospitalisation.
• Sensitivity analyses confirmed the robustness of the findings.

IN PRACTICE:

“Treatment with dexamethasone within 12 hours of antibiotic treatment was associated with a reduced risk of death in children with pneumococcal meningitis. Our findings support the use of adjunctive dexamethasone to reduce the risk of death in children hospitalised with pneumococcal meningitis,” the authors wrote.

SOURCE:

The study was led by Anna Giolito, MD, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France. It was published online in April 2025 in The Lancet Child & Adolescent Health.  

LIMITATIONS:

The study was limited by unmeasured covariates, which may have introduced a confounding bias. The absence of long-term follow-up prevented the optimal analysis of secondary endpoints, particularly hearing loss and neurological sequelae. The surveillance system only recorded infectious complications during hospitalisation, limiting the assessment of other potential steroid-related adverse effects such as hyperglycaemia, behavioural changes, and gastrointestinal issues. Additionally, variations were present in the administered dexamethasone doses.

DISCLOSURES:

The study was funded by Pfizer, Association Clinique et Thérapeutique Infantile du Val-de-Marne (ACTIV), and the National Institute of Health and Medical Research (Inserm) Centre. Three authors reported receiving travel grants or personal fees from various pharmaceutical companies. Details are provided in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.