Hearing impairment in childhood bacterial meningitis is little relieved by dexamethasone or glycerol

• Published in: Pediatrics (Evanston) Vol. 125; no. 1; pp. e1 - e8
• Main Authors: Peltola, Heikki, Roine, Irmeli, Fernández, Josefina, González Mata, Antonio, Zavala, Inés, Gonzalez Ayala, Silvia, Arbo, Antonio, Bologna, Rosa, Goyo, José, López, Eduardo, Miño, Greta, Dourado de Andrade, Solange, Sarna, Seppo, Jauhiainen, Tapani
• Format: Journal Article
• Language: English
• Published: United States American Academy of Pediatrics 01-01-2010
• Subjects: Administration, Oral; Adolescent; Alcohol; Audiometry; Ceftriaxone - administration & dosage; Child; Child, Preschool; Children & youth; Confidence Intervals; Dexamethasone - administration & dosage; Dose-Response Relationship, Drug; Double-Blind Method; Drug Administration Schedule; Drug Therapy, Combination; Female; Follow-Up Studies; Glycerol - administration & dosage; Hearing loss; Hearing Loss - drug therapy; Hearing Loss - etiology; Hearing Loss - prevention & control; Humans; Infant; Infusions, Intravenous; Logistic Models; Male; Meningitis; Meningitis, Bacterial - complications; Meningitis, Bacterial - drug therapy; Meningitis, Bacterial - microbiology; Meningitis, Haemophilus - complications; Meningitis, Haemophilus - diagnosis; Meningitis, Haemophilus - drug therapy; Meningitis, Pneumococcal - complications; Meningitis, Pneumococcal - diagnosis; Meningitis, Pneumococcal - drug therapy; Odds Ratio; Pediatrics; Probability; Prospective Studies; Risk Assessment; Severity of Illness Index; Time Factors; Treatment Outcome
• ISSN: 0031-4005; 1098-4275
• DOI: 10.1542/peds.2009-0395

Several studies have evaluated dexamethasone for prevention of hearing loss in childhood bacterial meningitis, but results have varied. We compared dexamethasone and/or glycerol recipients with placebo recipients, and measured hearing at 3 threshold levels.
Children aged 2 months to 16 years with meningitis were treated with ceftriaxone but were double-blindly randomly assigned to receive adjuvant dexamethasone intravenously, glycerol orally, both agents, or neither agent. We used the Glasgow coma scale to grade the presenting status. The end points were the better ear's ability to detect sounds of >40 dB, >or=60 dB, and >or=80 dB, with these thresholds indicating any, moderate-to-severe, or severe impairment, respectively. All tests were interpreted by an external audiologist. Influence of covariates in the treatment groups was examined by binary logistic regression.
Of the 383 children, mostly with meningitis caused by Haemophilus influenzae type b or Streptococcus pneumoniae, 101 received dexamethasone, 95 received dexamethasone and glycerol, 92 received glycerol, and 95 received placebo. Only the presenting condition and young age predicted impairment independently through all threshold levels. Each lowering point in the Glasgow scale increased the risk by 15% to 21% (odds ratio: 1.20, 1.21, and 1.15 [95% confidence interval: 1.06-1.35, 1.07-1.37, and 1.01-1.31]; P = .005, .003, and .039) for any, moderate-to-severe, or severe impairment, respectively. Each increasing month of age decreased the risk by 2% to 6% (P = .0001, .0007, and .041, respectively). Neither dexamethasone nor glycerol prevented hearing loss at these levels regardless of the causative agent or timing of antimicrobial agent.
With bacterial meningitis, the child's presenting status and young age are the most important predictors of hearing impairment. Little relief is obtained from current adjuvant medications.