Adjunctive dexamethasone lowers death risk in hospitalized children with pneumococcal meningitis

In the treatment of children hospitalized with pneumococcal meningitis, administering dexamethasone within 12 hours of initiating antibiotics appears reduce the 30-day risk of death, according to a retrospective study.

Researchers used data from a French national surveillance system of paediatric pneumococcal meningitis, which covered 238 French paediatric wards working with 168 microbiology laboratories. They identified 1,765 cases of pneumococcal meningitis requiring hospitalization in children aged 0–17 years.

The primary outcome of 30-day all-cause death after hospital admission was compared between children who did and those who did not receive adjunctive therapy with dexamethasone treatment (0.15 mg/kg every 6 hours for 4 days, per national guidelines) within 12 hours of antibiotic treatment.

The analysis included 1,231 children (median age 1.1 years, 40 percent female), of which 650 (53 percent) received dexamethasone and 581 (47 percent) did not receive dexamethasone. A total of 108 children (9 percent) died.

Within 30 days of hospitalization, 105 deaths (9 percent) were recorded, including 36 (6 percent) in the dexamethasone group and 69 (12 percent) in the no-dexamethasone group. In inverse probability treatment weighting analysis, the adjusted 30-day death rate was lower in the dexamethasone group than in the no-dexamethasone group (6 percent vs 12 percent; marginal odds ratio, 0.39, 95 percent confidence interval, 0.23–0.65).

All sensitivity analyses yielded consistent results.

The findings support the use of dexamethasone to mitigate the risk of death in paediatric pneumococcal meningitis.