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  1. 1. Contact: Jaida Butler T: (44) 01243 770674 E: jbutler@wiley.co.uk For Immediate Release Change policy: Giving steroids to children with meningitis can reduce hearing loss and lower the incidence of long-term brain damage and can save lives in both children and adults with meningitis Research News in the Cochrane Database of Systematic Reviews Antibiotics are essential and life-saving in the treatment of bacterial meningitis, but for years doctors have debated whether to give corticosteroids at the same time. The inflammation caused by meningitis can actually be made worse by antibiotics in the short term, as the bacteria killed by antibiotics release various toxins. Experimental evidence showed that steroids reduce this inflammation, which carries with it the risk of permanent brain damage and/or deafness from impaired blood supply. Many controlled trials in humans have looked at the effect of adding corticosteroid therapy to antibiotics in acute bacterial meningitis, but each trial on its own has not given conclusive results. A review published in the July update of the Cochrane Database of Systematic Reviews settles the argument. Giving corticosteroids with antibiotics more than halves the number of children who suffer from severe hearing loss – a reduction from 8% to 3%. The effect on reducing deaths and brain damage was less dramatic, but even so, in both cases children benefited from using the two drugs together. For adults with bacterial meningitis, giving corticosteroids would save one life for every 10 patients treated – a reduction from 18 to 8%. “Our analysis of currently available data shows that there is strong evidence for giving corticosteroids to children suspected of having bacterial meningitis”, says lead author, Dr Diederik van de Beek of the Department of Neurology at the Academic Medical Center University of Amsterdam. This authoritative review was compiled with the help of an international team involving Dr Jan de Gans from the Netherlands, Prof Peter McIntyre from Australia, and Prof Kameshwar Prasad from India. They recommend that, in developed countries, patients are given a four-day course of dexamethasone (0.6mg/kg daily). As it is important to give the first steroid dose before, or at least with, the first dose of intravenous antibiotics in hospital, use of
  2. 2. dexamethasone is less applicable in countries where there is likely to be a significant delay before hospital treatment. Notes for Editors 1. van de Beek D, de Gans J, McIntyre P, Prasad K Corticosteroids in acute bacterial meningitis (Cochrane Review). In: The Cochrane Library, Issue 3, 2003 2. The Cochrane Collaboration started in 1992. Its headquarters are in Oxford, UK, and it is an international organization with bases and participants throughout the world. The Cochrane Collaboration (http://www.cochrane.org) aims to help people make well-informed decisions about healthcare by preparing, maintaining and promoting the accessibility of up-to-date systematic reviews of the effects of healthcare interventions. It is a not-for- profit organization, established as a company, limited by guarantee, and registered as a charity in the United Kingdom, serving the information needs of physicians, clinical researchers, nurses, midwives, dentists, patients and healthcare policymakers at medical institutions, universities, corporations, and healthcare organizations around the world, including the UK’s National Health Service. The Collaboration encompasses an established network of 50 research groups worldwide that prepare and maintain Cochrane reviews, covering a range of medical specialties. Approximately 10,000 people are actively involved in the work of The Cochrane Collaboration, almost all on a voluntary basis. 3. John Wiley & Sons Ltd., with its headquarters in Chichester, England, is the largest subsidiary of John Wiley & Sons, Inc. Founded in 1807, John Wiley & Sons, Inc., provides must-have content and services to customers worldwide. Its core businesses include scientific, technical, and medical journals, encyclopedias, books, and online products and services; professional and consumer books and subscription services; and educational materials for undergraduate and graduate students and lifelong learners. Wiley has publishing, marketing, and distribution centers in the United States, Canada, Europe, Asia, and Australia. The company is listed on the New York Stock Exchange under the symbols JWa and JWb. Wiley's Internet site can be accessed at http://www.wiley.com/. 4. For further information about the review, please contact Jaida Butler on 01243 770674 or jbutler@wiley.co.uk