Association of Corticosteroid Treatment With Outcomes in Pediatric Patients With Bacterial Meningitis: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Purpose: Controversy has arisen among the overall benefit and potential risks in the use of corticosteroids for the treatment of pediatric bacterial meningitis. This systematic review and meta-analysis aims to provide evidence of the use of corticosteroids in the treatment of bacterial meningitis in children. Methods: Electronic databases (PubMed, Embase, Cochrane Central Register of Controlled Trials, and other databases) were searched from inception until March 9, 2021. Randomized clinical trials focused on corticosteroids as adjuvant therapy in pediatric bacterial meningitis were considered eligible. The primary outcomes were hearing loss and neurologic sequelae. Secondary outcomes were mean days before resolution of fever, mortality, secondary fever, and reactive arthritis. Fixed- or random-effects models were used to evaluate the association between corticosteroids therapy and outcomes by calculating risk ratios (RRs) and mean differences (MDs) with corresponding 95% CIs. Two independent reviewers completed citation screening, data extraction, and risk assessment. Findings: Twenty-nine studies with 3433 patients were included. An obvious benefit was found in the treatment of corticosteroids in hearing loss (RR = 0.62; 95% CI, 0.47-0.81;I-2 = 17%; P = 0.0006). No benefit was found in the rate of neurologic sequelae. However, obvious benefit was found in the low-dosage subgroup (0.6 mg/kg per day) (RR = 0.60; 95% CI, 0.47-0.77; I-2 = 0%; P < 0.0001) but not in the high-dosage subgroup (0.8 mg/kg per day). An increasing rate of secondary fever was found when using corticosteroids (RR = 1.29; 95% CI, 1.10-1.51; I-2 = 13%; P = 0.001). Corticosteroids could significantly decrease the mean days before resolution of fever (MD = -1.48; 95% CI, -1.79 to -1.17; I-2 = 84%, P < 0.00001). No difference was found in the rate of mortality and reactive arthritis. (C) 2022 Elsevier Inc.

Automated summary

The use of corticosteroids for the treatment of pediatric bacterial meningitis has been controversial. A systematic review and meta-analysis were conducted to assess the benefits and risks of corticosteroids in this context. The findings showed that corticosteroid treatment reduced the risk of hearing loss but had no significant benefit in preventing neurologic sequelae. Low-dose corticosteroids were found to be more effective than high-dose corticosteroids. However, the use of corticosteroids was associated with an increased risk of secondary fever. Additionally, corticosteroids significantly shortened the duration of fever. There was no significant difference in mortality rate and reactive arthritis between the corticosteroid and control groups.