A 30-year perspective of low-dose dexamethasone, a single dose of mannitol and antiseizures prophylaxis on the prognosis of pneumococcal meningitis.
| Autor: | Cabellos C; Infectious Diseases Department, Hospital Universitari Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Spain.; Centro de Investigación Biomédica de Enfermedades Infecciosas (CIBERINFEC), ISCIII, Madrid, Spain.; Departament de Ciències Clíniques, University of Barcelona, Barcelona, Spain., Guillem L; Infectious Diseases Department, Hospital Universitari Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Spain.; Centro de Investigación Biomédica de Enfermedades Infecciosas (CIBERINFEC), ISCIII, Madrid, Spain.; Departament de Ciències Clíniques, University of Barcelona, Barcelona, Spain., Pelegrin I; Infectious Diseases Department, Hospital Universitari Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Spain.; Centro de Investigación Biomédica de Enfermedades Infecciosas (CIBERINFEC), ISCIII, Madrid, Spain.; Departament de Ciències Clíniques, University of Barcelona, Barcelona, Spain., Tubau F; Microbiology Department, Hospital Universitari Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Spain.; CIBER de Enfermedades Respiratorias (CIBERes), ISCIII, Madrid, Spain.; Departament of Pathology and Experimental Therapeutics, University of Barcelona, Barcelona, Spain., Ardanuy C; Microbiology Department, Hospital Universitari Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Spain.; CIBER de Enfermedades Respiratorias (CIBERes), ISCIII, Madrid, Spain.; Departament of Pathology and Experimental Therapeutics, University of Barcelona, Barcelona, Spain., Gudiol F; Infectious Diseases Department, Hospital Universitari Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Spain.; Centro de Investigación Biomédica de Enfermedades Infecciosas (CIBERINFEC), ISCIII, Madrid, Spain.; Departament de Ciències Clíniques, University of Barcelona, Barcelona, Spain., Ariza J; Infectious Diseases Department, Hospital Universitari Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Spain.; Centro de Investigación Biomédica de Enfermedades Infecciosas (CIBERINFEC), ISCIII, Madrid, Spain.; Departament de Ciències Clíniques, University of Barcelona, Barcelona, Spain., Viladrich PF; Infectious Diseases Department, Hospital Universitari Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Spain.; Centro de Investigación Biomédica de Enfermedades Infecciosas (CIBERINFEC), ISCIII, Madrid, Spain.; Departament de Ciències Clíniques, University of Barcelona, Barcelona, Spain. |
|---|---|
| Jazyk: | angličtina |
| Zdroj: | Infectious diseases (London, England) [Infect Dis (Lond)] 2024 Nov; Vol. 56 (11), pp. 974-982. Date of Electronic Publication: 2024 Jun 26. |
| DOI: | 10.1080/23744235.2024.2370967 |
| Abstrakt: | Objectives: This study details the accumulated experience of more than 31 years using a low-dose systematic dexamethasone protocol with mannitol and antiseizure prophylaxis for the treatment of suspected pneumococcal meningitis. Methods: Data have been prospectively collected for the period1977-2018. From 1987, patients with suspected pneumococcal meningitis received 12 mg dexamethasone followed by 4 mg/6 h for 48 h, started before or with the first antibiotic dose. They also received (1) a single intravenous dose of 0.5-1 g/Kg mannitol, and (2) antiseizure prophylaxis with phenytoin. Results: In total, 363 episodes of pneumococcal meningitis were recorded. Of these, 242 were treated with the dexamethasone protocol after 1987 and 121 were treated without the protocol. Overall mortality was 11.6% (28/242) among patients treated with dexamethasone and 35% (43/121) among those treated without dexamethasone ( p = 0.000). Early mortality was significantly lower at 5.8% (14/242) with dexamethasone and 24% (29/121) without dexamethasone ( p = 0.000). Finally, neurological mortality was significantly lower at 7.4% (18/242) with dexamethasone and 23% (28/121) without dexamethasone ( p = 0.000). Conclusions: A low dose of dexamethasone along with a single dose of mannitol and antiseizures prophylaxis might be useful for reducing both overall and early mortality in pneumococcal meningitis in adult patients. |
| Databáze: | MEDLINE |
| Externí odkaz: |
|