Evidence map›Paper›PMID 12432041›Full record

Trial reportThe New England journal of medicine2002

Dexamethasone in adults with bacterial meningitis.

Jan de Gans, Diederik van de Beek, European Dexamethasone in Adulthood Bacterial Meningitis Study Investigators

Registry-linked trialOpen access · bronzeAbstract readClinical TrialMulticenter StudyRandomized Controlled Trial
PubMed Publisher
In one paragraph

Trial report in The New England journal of medicine, 2002. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT00162578 (Vancomycin Concentration in Cerebrospinal Fluid During Pneumococcal Meningitis Treated With Dexamethasone), which is not on this map. Cited by 324 papers, 18 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
324citing papers in PubMed, 18 pooled it
38.2field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT00162578 completednot on this map

Vancomycin Concentration in Cerebrospinal Fluid During Pneumococcal Meningitis Treated With Dexamethasone

TypeobservationalSponsorAssistance Publique - Hôpitaux de ParisRan2002 to 2005Enrolled14ConditionsPneumococcal Meningitis
3 · Its place in the literature

Who cites it

324 citing papers in PubMed, 18 syntheses or guidelines pooled it, 1,199 citations in OpenAlex.

  1. Pooled it
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  6. Non-corticosteroid adjuvant therapies for acute bacterial meningitis.The Cochrane database of systematic reviews · 2021
    Pooled it
  7. The role of adjuvant systemic steroids in the management of periorbital cellulitis secondary to sinusitis: a systematic review and meta-analysis.European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery · 2021
    Pooled it
  8. Pooled it
  9. Guideline
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  13. Osmotic therapies added to antibiotics for acute bacterial meningitis.The Cochrane database of systematic reviews · 2018
    Pooled it
  14. Pooled it
  15. Corticosteroids for acute bacterial meningitis.The Cochrane database of systematic reviews · 2015
    Pooled it
  16. Pooled it
  17. Pooled it
  18. Osmotic therapies added to antibiotics for acute bacterial meningitis.The Cochrane database of systematic reviews · 2013
    Pooled it
  19. Trial
  20. Trial

264 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

3 authors at 2 institutions in 1 country.

Jan de GansDepartment of Neurology, Academic Medical Center, Amsterdam, The Netherlands. j.degans@amc.uva.nl
Diederik van de Beek
European Dexamethasone in Adulthood Bacterial Meningitis Study Investigators
Academic Medical Center · NLUniversity of Amsterdam · NL

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundMortality and morbidity rates are high among adults with acute bacterial meningitis, especially those with pneumococcal meningitis. In studies of bacterial meningitis in animals, adjuvant treatment with corticosteroids has beneficial effects.

methodsWe conducted a prospective, randomized, double-blind, multicenter trial of adjuvant treatment with dexamethasone, as compared with placebo, in adults with acute bacterial meningitis. Dexamethasone (10 mg) or placebo was administered 15 to 20 minutes before or with the first dose of antibiotic and was given every 6 hours for four days. The primary outcome measure was the score on the Glasgow Outcome Scale at eight weeks (a score of 5, indicating a favorable outcome, vs. a score of 1 to 4, indicating an unfavorable outcome). A subgroup analysis according to the causative organism was performed. Analyses were performed on an intention-to-treat basis.

resultsA total of 301 patients were randomly assigned to a treatment group: 157 to the dexamethasone group and 144 to the placebo group. The base-line characteristics of the two groups were similar. Treatment with dexamethasone was associated with a reduction in the risk of an unfavorable outcome (relative risk, 0.59; 95 percent confidence interval, 0.37 to 0.94; P=0.03). Treatment with dexamethasone was also associated with a reduction in mortality (relative risk of death, 0.48; 95 percent confidence interval, 0.24 to 0.96; P=0.04). Among the patients with pneumococcal meningitis, there were unfavorable outcomes in 26 percent of the dexamethasone group, as compared with 52 percent of the placebo group (relative risk, 0.50; 95 percent confidence interval, 0.30 to 0.83; P=0.006). Gastrointestinal bleeding occurred in two patients in the dexamethasone group and in five patients in the placebo group.

conclusionsEarly treatment with dexamethasone improves the outcome in adults with acute bacterial meningitis and does not increase the risk of gastrointestinal bleeding.

Indexed as

Acute DiseaseAdultAnti-Bacterial AgentsChemotherapy, AdjuvantDexamethasoneDouble-Blind MethodFemaleGastrointestinal HemorrhageGlucocorticoidsHumansMaleMeningitis, BacterialMeningitis, MeningococcalMeningitis, PneumococcalMiddle AgedProspective StudiesAnti-Bacterial AgentsDexamethasoneGlucocorticoids

Identifiers

PMID12432041
OpenAlexW2376390361

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.