Intervention Review

Corticosteroids for acute bacterial meningitis

  1. Matthijs C Brouwer1,
  2. Peter McIntyre2,
  3. Kameshwar Prasad3,
  4. Diederik van de Beek4,*

Editorial Group: Cochrane Acute Respiratory Infections Group

Published Online: 12 SEP 2015

Assessed as up-to-date: 3 FEB 2015

DOI: 10.1002/14651858.CD004405.pub5

How to Cite

Brouwer MC, McIntyre P, Prasad K, van de Beek D. Corticosteroids for acute bacterial meningitis. Cochrane Database of Systematic Reviews 2015, Issue 9. Art. No.: CD004405. DOI: 10.1002/14651858.CD004405.pub5.

Author Information

  1. 1

    Academic Medical Center University of Amsterdam, Department of Neurology, Center for Infection and Immunity Amsterdam (CINIMA), Amsterdam, Netherlands

  2. 2

    Children's Hospital at Westmead and University of Sydney, National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, Sydney, NSW, Australia

  3. 3

    All India Institute of Medical Sciences, Department of Neurology, New Delhi, India

  4. 4

    Academic Medical Center, University of Amsterdam, Department of Neurology, H2-217, Amsterdam, Netherlands

*Diederik van de Beek, Department of Neurology, H2-217, Academic Medical Center, University of Amsterdam, P.O. Box 22660, Amsterdam, 1100 DE, Netherlands.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 12 SEP 2015




  1. Top of page
  2. Abstract
  3. Plain language summary
  4. Laienverständliche Zusammenfassung
  5. Laički sažetak


In experimental studies, the outcome of bacterial meningitis has been related to the severity of inflammation in the subarachnoid space. Corticosteroids reduce this inflammatory response.


To examine the effect of adjuvant corticosteroid therapy versus placebo on mortality, hearing loss and neurological sequelae in people of all ages with acute bacterial meningitis.

Search methods

We searched CENTRAL (2015, Issue 1), MEDLINE (1966 to January week 4, 2015), EMBASE (1974 to February 2015), Web of Science (2010 to February 2015), CINAHL (2010 to February 2015) and LILACS (2010 to February 2015).

Selection criteria

Randomised controlled trials (RCTs) of corticosteroids for acute bacterial meningitis.

Data collection and analysis

We scored RCTs for methodological quality. We collected outcomes and adverse effects. We performed subgroup analyses for children and adults, causative organisms, low-income versus high-income countries, time of steroid administration and study quality.

Main results

We included 25 studies involving 4121 participants (2511 children and 1517 adults; 93 mixed population). Four studies were of high quality with no risk of bias, 14 of medium quality and seven of low quality, indicating a moderate risk of bias for the total analysis. Nine studies were performed in low-income countries and 16 in high-income countries.

Corticosteroids were associated with a non-significant reduction in mortality (17.8% versus 19.9%; risk ratio (RR) 0.90, 95% confidence interval (CI) 0.80 to 1.01, P value = 0.07). A similar non-significant reduction in mortality was observed in adults receiving corticosteroids (RR 0.74, 95% CI 0.53 to 1.05, P value = 0.09). Corticosteroids were associated with lower rates of severe hearing loss (RR 0.67, 95% CI 0.51 to 0.88), any hearing loss (RR 0.74, 95% CI 0.63 to 0.87) and neurological sequelae (RR 0.83, 95% CI 0.69 to 1.00).

Subgroup analyses for causative organisms showed that corticosteroids reduced mortality in Streptococcus pneumoniae (S. pneumoniae) meningitis (RR 0.84, 95% CI 0.72 to 0.98), but not in Haemophilus influenzae (H. influenzae) orNeisseria meningitidis (N. meningitidis) meningitis. Corticosteroids reduced severe hearing loss in children with H. influenzae meningitis (RR 0.34, 95% CI 0.20 to 0.59) but not in children with meningitis due to non-Haemophilus species.

In high-income countries, corticosteroids reduced severe hearing loss (RR 0.51, 95% CI 0.35 to 0.73), any hearing loss (RR 0.58, 95% CI 0.45 to 0.73) and short-term neurological sequelae (RR 0.64, 95% CI 0.48 to 0.85). There was no beneficial effect of corticosteroid therapy in low-income countries.

Subgroup analysis for study quality showed no effect of corticosteroids on severe hearing loss in high-quality studies.

Corticosteroid treatment was associated with an increase in recurrent fever (RR 1.27, 95% CI 1.09 to 1.47), but not with other adverse events.

Authors' conclusions

Corticosteroids significantly reduced hearing loss and neurological sequelae, but did not reduce overall mortality. Data support the use of corticosteroids in patients with bacterial meningitis in high-income countries. We found no beneficial effect in low-income countries.


Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. Laienverständliche Zusammenfassung
  5. Laički sažetak

Corticosteroids for bacterial meningitis

Review question

We reviewed the evidence about the effect of corticosteroids on mortality, hearing loss and/or neurological sequelae (such as hearing loss, neurologic deficits) in adults and children with acute bacterial meningitis.


Acute bacterial meningitis is an infection of the meninges (the system of membranes that envelops the brain and spinal cord), which often causes hearing loss. Bacterial meningitis is fatal in 5% to 40% of children and 20% to 50% of adults despite treatment with adequate antibiotics. It is caused by bacteria that usually spread from an ear or respiratory infection and is treated with antibiotics.

Corticosteroids are drugs that can reduce the inflammation caused by infection. This inflammation has been shown to aggravate damage to the nervous system in experimental meningitis studies in animals. Research on the use of corticosteroids in addition to antibiotics has had conflicting results.

We wanted to discover whether use of corticosteroids was better of worse than placebo.

Study characteristics

The evidence is current to February 2015. We identified 25 trials, including 4121 participants with acute bacterial meningitis of which seven were performed in adults (over 16 years old), two included both children and adults and the other were performed in children. In 22 studies the corticosteroid used was dexamethasone, in three others hydrocortisone or prednisone were used. Nine studies were performed in low-income countries and 16 in high-income countries.

Key results

This review found that the corticosteroid dexamethasone did not significantly reduce the death rate (17.8% versus 19.9%). Patients treated with corticosteroids had significantly lower rates of severe hearing loss (6.0% versus 9.3%), any hearing loss (13.8% versus 19.0%) and neurological sequelae (17.9% versus 21.6%).

An analysis for different bacteria causing meningitis showed that patients with meningitis due to Streptococcus pneumoniae (S. pneumoniae) treated with corticosteroids had a lower death rate (29.9% versus 36.0%), while no effect on mortality was seen in patients with Haemophilus influenzae (H. influenzae) and Neisseria meningitidis (N. meningitidis) meningitis.

In high-income countries, corticosteroids reduced severe hearing loss, any hearing loss and short-term neurological sequelae. There was no beneficial effect of corticosteroid therapy in low-income countries.

Corticosteroids decreased the rate of hearing loss in children with meningitis due to H. influenzae (4% versus 12%), but not in children with meningitis due to other bacteria.

Dexamethasone increased the rate of recurrent fever (28% versus 22%) but was not associated with other adverse events.

Quality of the evidence

Out of 25 studies, four were of high quality, 14 of medium quality and seven of low quality, leading to a moderate overall quality of evidence.


Laienverständliche Zusammenfassung

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. Laienverständliche Zusammenfassung
  5. Laički sažetak

Kortikosteroide bei bakterieller Meningitis (Hirnhautentzündung)


Wir begutachteten die Evidenz über die Wirkung von Kortikosteroiden auf Sterblichkeit, Hörverlust und/oder neurologische Folgekrankheiten (wie Hörverlust, neurologische Ausfälle) bei Erwachsenen und Kindern mit akuter bakterieller Meningitis.


Bei der akuten bakteriellen Meningitis handelt es sich um eine Infektion der Hirnhaut (das Membransystem, welches das Gehirn und das Rückenmark umhüllt). Sie ist oft Ursache für Hörverlust. Die bakterielle Meningitis hat trotz der Behandlung mit geeigneten Antibiotika bei 5 bis 40% der erkrankten Kinder und bei 20 bis 50% der erkrankten Erwachsenen einen tödlichen Ausgang. Sie wird durch Bakterien verursacht, die meistens von einer Infektion der Ohren oder Atemwege auf die Hirnhaut übergehen, und wird mit Antibiotika behandelt.

Bei Kortikosteroiden handelt es sich um Medikamente, welche die durch die Infektion verursachte Entzündung abschwächen können. Von dieser Entzündung wurde in Meningitis-Studien anhand von Tierversuchen nachgewiesen, dass sie den Schaden am Nervensystem vergrößern kann. Die Forschung zur Anwendung von Kortikosteroiden zusätzlich zu Antibiotika ergab widersprüchliche Ergebnisse.

Wir wollten wissen, ob die Anwendung von Kortikosteroiden zu besseren oder schlechteren Ergebnissen führt als ein Placebo.


Die Evidenz ist auf dem Stand von Februar 2015. Wir fanden 25 Studien mit 4121 Teilnehmern mit akuter bakterieller Meningitis. Sieben Studien wurden an Erwachsenen (über 16 Jahre) durchgeführt, zwei schlossen sowohl Kinder als auch Erwachsene ein, und die übrigen wurden an Kindern durchgeführt. In 22 Studien handelte es sich bei dem verwendeten Kortikosteroid um Dexamethason, in den drei übrigen wurde Hydrocortison oder Prednison verwendet. Neun Studien wurden in einkommensschwachen Ländern und 16 in einkommensstarken Ländern durchgeführt.


Dieser Review zeigte, dass Dexamethason die Sterberate nicht signifikant verringerte (17,8% im Vergleich zu 19,9%). Bei den mit Kortikosteroiden behandelten Patienten erlitt ein signifikant geringerer Anteil der Patienten schwere Hörverluste (6,0% im Vergleich zu 9,3%), Hörschäden (13,8% anstatt 19,0%) oder neurologische Folgeerkrankungen (17,9% anstatt 21,6%).

Eine Auswertung nach den verschiedenen, Meningitis verursachenden Bakterien zeigte, dass die Sterblichkeitsrate bei Patienten mit einer von Streptococcus pneumoniae (S. pneumoniae) verursachten Meningitis, die mit Kortikosteroiden behandelt wurden, geringer war (29,9% anstatt 36,0%). Bei Patienten mit einer Meningitis, die durch Haemophilus influenzae (H. influenzae) oder Neisseria meningitidis (N. meningitidis) verursacht wurde, war keine Veränderung der Sterblichkeit festzustellen.

In einkommensstarken Ländern gab es mit Kortikosteroiden weniger Fälle von schwerem Hörverlust, Hörschäden und kurzfristigen neurologischen Folgeerkrankungen. In einkommensschwachen Ländern war keine positive Wirkung einer Kortikosteorid-Therapie festzustellen.

Bei Kindern mit einer durch H. influenzae verursachten Meningitis verringerten Kortikosteoride die Hörverlust-Rate (4% im Vergleich zu 12%), jedoch nicht bei Kindern mit einer durch andere Bakterien verursachten Meningitis.

Dexamethason erhöhte die Häufigkeit von wiederkehrendem Fieber (28% anstatt 22%), wurde aber nicht mit anderen unerwünschten Ereignissen in Verbindung gebracht.

Qualität der Evidenz

Von 25 Studien waren fünf von hoher Qualität, 14 von mittlerer Qualität und 7 von niedriger Qualität, woraus sich insgesamt eine Evidenz von moderater Qualität ergibt.

Anmerkungen zur Übersetzung

Freigegeben durch Cochrane Schweiz.


Laički sažetak

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. Laienverständliche Zusammenfassung
  5. Laički sažetak

Kortikosteroidi za bakterijski meningitis

Pitanje koje postavlja pregled

U ovom Cochrane sustavnom pregledu analizirani su dokazi o učinku kortikosteroida na stopu smrtnosti, gubitak sluha i/ili neurološke posljedice (poput gubitka sluha, neuroloških deficita) u odraslih i djece s akutnim bakterijskim meningitisom.

Dosadašnje spoznaje

Akutni bakterijski meningitis je infekcija moždanih ovojnica (sustav membrana koje okružuju mozak i leđnu moždinu) koja često uzrokuje gubitak sluha. Bakterijski meningitis je smrtonosan u 5 do 40% djece i 20 do 50% odraslih unatoč terapiji prikladnim antibioticima. Uzrokuju ga bakterije koje se najčešće prošire iz infekcija uha ili dišnih puteva i liječi se antibioticima.

Kortikosteroidi su lijekovi koji mogu umanjiti upalu uzrokovanu infekcijom. Eksperimentalne studije meningitisa na životinjama su pokazale da ta upala pogoršava oštećenje živčanog sustava. Istraživanja o korištenju kortikosteroida kao dodatak antibioticima imala su oprečne rezultate.

Cilj ovog Cochrane sustavnog pregleda bio je analizirati je li uporaba kortikosteroida bolja ili lošija od placeba.

Značajke studija

Pretražena je literatura objavljena do veljače 2015. Pronađeno je 25 studija koje su uključivale 4121 sudionika s akutnim bakterijskim meningitisom, od kojih je sedam provedeno na odraslim osobama (iznad 16 godina), dvije su uključivale djecu i odrasle, a ostale su provedene na djeci. U 22 studije analizirani kortikosteroid bio je deksametazon, u ostale tri koristio se hidrokortizon i prednizon. Devet studija provedeno je zemljama s niskim prihodima i 16 u zemljama s visokim prihodima.

Ključni rezultati

Pregled je našao da deksametazon nije značajno smanjio stopu smrtnosti (17,8 u usporedbi s 19,9%). Pacijenti koji su primali kortikosteroide imali su značajno niže stope teškog gubitka sluha (6,0% u usporedbi s 9,3%) i bilo kakvog gubitka sluha (13,8 naprema 19%) te neuroloških posljedica (17,9 naprema 21,6%).

Analiza različitih bakterija koje uzrokuju meningitis pokazala je da pacijenti s meningitisom uzrokovanim bakterijom Streptococcus pneumoniae (S. pneumoniae)liječeni kortikosteroidima imali nižu stopu smrtnosti (29.9 naprema 36.0%), dok nije primijećen učinak na stopu smrtnosti u pacijenata s meningitisom uzrokovanim Haemophilus influenzae (H. influenzae) i Neisseria meningitidis (N. meningitidis).

U zemljama visokih prihoda kortikosteroidi su smanjili ozbiljni gubitak sluha, bilo kakav gubitak sluha i kratkoročne neurološke posljedice. Nije bilo blagotvornog učinka kortikosteroida u zemljama niskih prihoda.

Kortikosteroidi su smanjili stopu gubitka sluha u djece s meningitisom uzrokovanim H. influenzae (4 naprema 12%) ali ne u djece s meningitisom uzrokovanim drugim bakterijama.

Deksametazon je povećao stopu ponavljajuće groznice (28 naprema 22%), ali nije bio povezan s drugim nuspojavama.

Kvaliteta dokaza

Od 25 studija, četiri je bilo visoke kvalitete, 14 umjerene kvalitete i sedam niske kvalitete, što sveukupno daje srednju kvalitetu dokaza.

Bilješke prijevoda

Hrvatski Cochrane
Preveo: Adam Galkovski
Ovaj sažetak preveden je u okviru volonterskog projekta prevođenja Cochrane sažetaka. Uključite se u projekt i pomozite nam u prevođenju brojnih preostalih Cochrane sažetaka koji su još uvijek dostupni samo na engleskom jeziku. Kontakt: