Ahsan T, Shahid M, Mahmood T, Jabeen R, Jehangir U, Saleem M, Ahmed N, Shaheer A
Medical Unit 2, Department of Medicine, Jinnah Postgraduate Medical Centre, Karachi.
J Pak Med Assoc. 2002 Jun;52(6):233-9.
To evaluate the role of dexamethasone as adjunctive therapy in adult acute bacterial meningitis (ABM) in two groups of patients treated with antibiotics alone or a combination of antibiotics and dexamethasone.
Systematic sampling interventional open cohort study.
Department of Medicine (Medical Unit II), Jinnah Postgraduate Medical Centre, Karachi.
Sixty eight patients aged 12-85 years admitted in Medical Unit II and diagnosed to have ABM. Patients were divided into two groups. Group A received anti-microbial therapy for 14 days (a combination of benzyl penicillin 6 million units I/V 6 hourly and chloramphenicol 1 gm I/V 6 hourly) and group B received the same antimicrobial therapy with dexamethasone 0.6 mg/kg/day in 3 divided doses for 4 days.
Differences in mortality and morbidity in the two groups and differences in the CSF inflammatory parameters between the two groups of patients.
There was early resolution of fever, headache and altered consciousness in group B as compared to group A. Cranial nerves involvement was lower in group B. There was no difference in the occurrence of other focal neurological deficits between the two groups. CSF inflammatory parameters (glucose, protein and WBC count) were significantly better in group B by day 5. No complications attributable to dexamethasone were seen in group B.
There was early resolution of symptoms and CSF inflammatory parameters in the group that received dexamethasone as adjuvant therapy. Mortality was lower in the group treated with dexamethasone but the difference was not statistically significant. Dexamethasone should be administered to all adults patients with ABM.
在两组分别接受单纯抗生素治疗或抗生素与地塞米松联合治疗的患者中,评估地塞米松作为辅助治疗在成人急性细菌性脑膜炎(ABM)中的作用。
系统抽样干预性开放队列研究。
卡拉奇真纳研究生医学中心医学部(第二医疗单元)。
68例年龄在12 - 85岁之间入住第二医疗单元且被诊断为ABM的患者。患者被分为两组。A组接受14天的抗菌治疗(苄星青霉素600万单位静脉注射,每6小时一次,氯霉素1克静脉注射,每6小时一次),B组接受相同的抗菌治疗,并加用地塞米松0.6毫克/千克/天,分3次给药,共4天。
两组患者死亡率和发病率的差异,以及两组患者脑脊液炎症参数的差异。
与A组相比,B组发热、头痛和意识改变症状出现较早缓解。B组颅神经受累情况较少。两组其他局灶性神经功能缺损的发生率无差异。到第5天时,B组脑脊液炎症参数(葡萄糖、蛋白质和白细胞计数)明显更好。B组未出现可归因于地塞米松的并发症。
接受地塞米松作为辅助治疗的组症状和脑脊液炎症参数出现较早缓解。接受地塞米松治疗的组死亡率较低,但差异无统计学意义。所有成人ABM患者均应给予地塞米松治疗。