Evidence map›Paper›PMID 18077808›Full record

Trial reportThe New England journal of medicine2007

Dexamethasone in Vietnamese adolescents and adults with bacterial meningitis.

Thi Hoang Mai Nguyen, Thi Hong Chau Tran, Guy Thwaites, Van Chuong Ly, Xuan Sinh Dinh, Trung Nghia Ho Dang, Quoc Tuan Dang, Duy Phong Nguyen, Hoan Phu Nguyen, Song Diep To and 11 more

Open access · bronzeAbstract readRandomized Controlled Trial
PubMed Publisher
In one paragraph

Trial report in The New England journal of medicine, 2007. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 72 papers, 15 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
72citing papers in PubMed, 15 pooled it
17.4field-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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

72 citing papers in PubMed, 15 syntheses or guidelines pooled it, 231 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
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  4. Non-corticosteroid adjuvant therapies for acute bacterial meningitis.The Cochrane database of systematic reviews · 2021
    Pooled it
  5. Guideline
  6. Pooled it
  7. Pooled it
  8. Osmotic therapies added to antibiotics for acute bacterial meningitis.The Cochrane database of systematic reviews · 2018
    Pooled it
  9. Corticosteroids for acute bacterial meningitis.The Cochrane database of systematic reviews · 2015
    Pooled it
  10. Pooled it
  11. Pooled it
  12. Osmotic therapies added to antibiotics for acute bacterial meningitis.The Cochrane database of systematic reviews · 2013
    Pooled it
  13. Pooled it
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  15. Pooled it
  16. Do Intracerebral Cytokine Responses Explain the Harmful Effects of Dexamethasone in Human Immunodeficiency Virus-associated Cryptococcal Meningitis?Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2019
    Trial
  17. Trial
  18. Trial
  19. Article
  20. Review

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

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

21 authors at 4 institutions in 2 countries.

Thi Hoang Mai NguyenHospital for Tropical Diseases, Ho Chi Minh City, Vietnam.
Thi Hong Chau Tran
Guy Thwaites
Van Chuong Ly
Xuan Sinh Dinh
Trung Nghia Ho Dang
Quoc Tuan Dang
Duy Phong Nguyen
Hoan Phu Nguyen
Song Diep To
van Vinh Chau Nguyen
Minh Duong Nguyen
James Campbell
Constance Schultsz
Chris Parry
M Estee Torok
Nicholas White
Tran Chinh Nguyen
Tinh Hien Tran
Kasia Stepniewska
Jeremy J Farrar
Oxford University Clinical Research Unit · VNHai phong University Of Medicine and Pharmacy · VNJohn Radcliffe Hospital · GBImperial College London · GB

Funding

Wellcome Trust
6 · The paper itself

Abstract

backgroundIt is uncertain whether all adults with bacterial meningitis benefit from treatment with adjunctive dexamethasone.

methodsWe conducted a randomized, double-blind, placebo-controlled trial of dexamethasone in 435 patients over the age of 14 years who had suspected bacterial meningitis. The goal was to determine whether dexamethasone reduced the risk of death at 1 month and the risk of death or disability at 6 months.

resultsA total of 217 patients were assigned to the dexamethasone group, and 218 to the placebo group. Bacterial meningitis was confirmed in 300 patients (69.0%), probable meningitis was diagnosed in 123 patients (28.3%), and an alternative diagnosis was made in 12 patients (2.8%). An intention-to-treat analysis of all the patients showed that dexamethasone was not associated with a significant reduction in the risk of death at 1 month (relative risk, 0.79; 95% confidence interval [CI], 0.45 to 1.39) or the risk of death or disability at 6 months (odds ratio, 0.74; 95% CI, 0.47 to 1.17). In patients with confirmed bacterial meningitis, however, there was a significant reduction in the risk of death at 1 month (relative risk, 0.43; 95% CI, 0.20 to 0.94) and in the risk of death or disability at 6 months (odds ratio, 0.56; 95% CI, 0.32 to 0.98). These effects were not found in patients with probable bacterial meningitis. Results of multivariate analysis indicated that dexamethasone treatment for patients with probable bacterial meningitis was significantly associated with an increased risk of death at 1 month, an observation that may be explained by cases of tuberculous meningitis in the treatment group.

conclusionsDexamethasone does not improve the outcome in all adolescents and adults with suspected bacterial meningitis; a beneficial effect appears to be confined to patients with microbiologically proven disease, including those who have received prior treatment with antibiotics. (Current Controlled Trials number, ISRCTN42986828 [controlled-trials.com] .).

Indexed as

AdolescentAdultAgedAged, 80 and overAnti-Bacterial AgentsCeftriaxoneCerebrospinal FluidDexamethasoneDouble-Blind MethodDrug Therapy, CombinationFemaleGlucocorticoidsHumansKaplan-Meier EstimateMaleMeningitis, BacterialAnti-Bacterial AgentsCeftriaxoneDexamethasoneGlucocorticoids

Identifiers

PMID18077808
OpenAlexW2112083867

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

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.