How Would You Treat Meningitis?
Treating Meningitis With Corticosteroids
Early treatment of meningitis with steroids may prevent some common meningitis complications.
By Jan Sheehan
Medically Reviewed by Lindsey Marcellin, MD, MPH
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Prompt treatment of meningitis with corticosteroids, such as dexamethasone, may prevent two common complications associated with the condition, hearing loss and seizures.
But the use of steroids in meningitis treatment is not without controversy. Some experts advocate their use, while others disagree.
Using Steroids to Treat Meningitis
Bacterial meningitis inflames the tissues and fluid around the brain, often creating pressure within the brain. Seizures may occur because of this increased pressure and inflammation.
Also, this inflammation and pressure can damage the nerves coming from the brain stem that control hearing, causing hearing loss. Steroids reduce inflammation and pressure within the brain, thus lessening a person's risk of having seizures and hearing problems.
“A number of studies have shown that when steroids are given along with antibiotics, there’s a lower risk of hearing loss,” says Nathan Litman, MD, director of pediatric infectious diseases at Children’s Hospital at Montefiore Medical Center in Bronx, New York.
Studies have also found that meningitis treatment with steroids significantly reduce the risk of death in adults.
When Are Steroids Used for Meningitis?
To be helpful, a steroid must be given right away. “They need to be administered at the same time that antibiotics are started,” says Dr. Litman. “If you wait eight to 12 hours, that’s too late.”
That’s because steroids work by halting the body’s inflammatory response. This will help prevent swelling and pressure in the brain and subsequent neurological complications. “Once hearing is lost due to meningitis, it’s usually irreversible,” says Litman.
Most children and adults of all ages can take steroids — the only exception is very young babies. Infants six weeks and younger are not likely to be treated with steroids because this meningitis treatment hasn’t been studied in this age group.
Pros of Steroid Treatment
A number of studies have shown that meningitis treatment with steroids clearly reduces the chance of deafness, and may lessen mortality as well.
In one review of 18 of those studies involving 2,750 patients, steroids appeared to reduce the risk of severe hearing loss in children. Additionally, an earlier study published in theBritish Medical Journalfound that death among adult meningitis patients taking steroids was less than half that of patients not receiving steroids. Study results have been mixed regarding fatality reductions in children, however.
Cons of Steroid Treatment
Corticosteroids can have adverse effects, including:
- Bleeding in the stomach
- Elevation of blood sugar
- Fluid retention
- Sleeping issues
- Mood swings
- Ringing in the ears (tinnitus)
There’s also concern that meningitis treatment with steroids could interfere with the body’s ability to recover from non-bacterial types of meningitis, such as meningitis caused by viruses or fungi.
“If it turns out that if it’s not bacterial meningitis, treatment with steroids could potentially do some harm,” says Litman. When test results rule out bacterial meningitis, steroids are typically stopped. Some doctors are also concerned that steroids could decrease the penetration of antibiotics into the fluid around the brain and spinal cord where bacteria reside, but not all experts agree about this.
But, depending on the patient, meningitis treatment with steroids may be warranted.
“From my perspective, the benefits of using steroids outweigh the potential risks, especially if given for a short period of time,” says Litman. Research on the use steroids to treat meningitis is continuing at a number of medical centers around the country.
Video: How Would You Treat Meningitis?
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