I would have to look at the COchran data but I recall that the effect on
hearing was for Hemophilus influenza Type B meningitis. It was not noted in
pneumococcal or meningiococcal bacterial meningitis.
Since we vaccinate against Hflu B, and even pneumoccocus, thus we haven't
seen but one case og H flu in recent years, we haven't been giving any
steroids when diagnosing meningitis. We prefer to start antibiotics as soon
as possible and avoid any delays.
On Thu, Aug 20, 2009 at 11:33 AM, Adriana Manikian <
[log in to unmask]> wrote:
> Dear Group,
> I would like to get a sense about current practice in the PEM community
> of concurrent administration of Decadron with first dose of empiric
> antibiotics in suspected meningitis.
> There is a reasonable evidence (Cochrane Review 2007) that Decadron
> when administered before or with the first dose of AB for total of 4 days
> in children with bacterial meningitis, significantly decreases the
> incidence of severe hearing loss (RR 0.35, CI 0.18-0.54).
> As viral meningitis is much more common, how does one make a
> decision to give Decadron before culture result or other evidence for
> possibly bacterial pathogen is avaialble?
> Frequently, we give AB immediately following and sometimes even
> before the LP, so then, when do you give Decadron?
> Would you give Decadron in the following cases?
> 4 month old with clear tap, but CSF pleocytosis WBC 30, 45%
> Neutrophils, 50% Lymphs, 0 RBC, glucose and protein normal, negative
> Gram stain
> 10 year old with turbid tap, CSF with WBC 550 predominant neutrophils,
> normal glucose, elevated protein, negative Gram stain
> 16 year old with grossly purulent tap, results of CSF labs pending.
> Thanks for sharing your opinions,
> Adriana Manikian
> PEM, NYU / Bellevue
> For more information, send mail to [log in to unmask] with the
> message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
Martin Herman, M.D.
Pediatric Emergency Specialists, P.C.
Lebonheur Children's Medical Center
Memphis Tn 38103
901 405 1407 ( office)
901 219 9202 ( cell)
901 287 5986 ( ED office)
901 287 6226 ( ED fax)
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