Revisão sistemática do uso da dexametasona como terapia adjuvante na meningite bacteriana em crianças

Abstract

Objective: To analyze the best available evidence from the last 15 years on the benefits of adjuvant therapy with dexamethasone for bacterial meningitis in children. Data sources: Randomized controlled trials comparing dexamethasone to placebo and/or other adjuvant therapies in patients with bacterial meningitis diagnosed by biochemical, cytological and/or microbiological data. Studies with patients from 29 days to 18 years of age, from 1996 to 2011, were searched at Medline, Lilacs and SciELO databases. The evaluated outcomes were mortality and development of neurological and/or hearing impairment. Studies related to tuberculous meningitis were excluded. Data synthesis: With the specified criteria, five published studies were identified corresponding to four study protocols. None of the studies showed differences between dexamethasone and placebo for the evaluated outcomes. All analyzed studies had high methodological quality (Jadad et al score=5). Conclusions: Current evidence is insufficient to support routine adjuvant therapy with dexamethasone to reduce mortality, hearing impairment, or neurological sequelae in pediatric patients with non-tuberculous bacterial meningitis.