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Canadian Journal of Infectious Diseases
Volume 5, Issue 5, Pages 210-215
Original Article

Dexamethasone Therapy for Bacterial Meningitis: Better Never Than Late?

Susan M King,1,2 Barbara Law,1 Joanne M Langley,1 Helen Heurter,1 Diane Bremner,1,2 Elaine E Wang,1,3 and Ronald Gold1

1Division of Infectious Disease, Departments of Pediatrics and Audiology, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
2Division of Infectious Diseases, The Health Sciences Centre, Winnipeg, Manitoba, Canada
3Division of Infectious Diseases, The Izaak Walton Killam Hospital, Halifax, Nova Scotia, Canada

Received 8 March 1994; Accepted 25 May 1994

Copyright © 1994 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


A multicentre randomized controlled trial was conducted in children with bacterial meningitis using dexamethasone or placebo for four days within 24 h of starting antibiotics. Primary outcomes were hearing loss and neurological abnormalities at 12 months after meningitis. The dexamethasone (n=50) and placebo (n=51) groups were similar in age, severity of illness and etiological agent. Hearing loss occurred in 10% and 11% of the dexamethasone and placebo groups and neurological deficits occurred in 20% and 18% of patients, respectively. Duodenal perforation occurred in one dexamethasone-treated child. In conclusion, there was no significant benefit in those receiving dexamethasone. The lack of benefit may have been due to the delay in administration of dexamethasone (median delay of 11 h after antibiotics). Therefore, if dexamethasone is used for meningitis it should be given immediately with the antibiotic.