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The evidence for benefit from steroids in bacterial meningitis is conflicting. During a 9-year period at a hospital for tropical diseases in Vietnam, 435 patients with suspected bacterial meningitis were randomized in double-blind fashion to receive either dexamethasone (0.4 mg/kg) or placebo twice a day for 4 days.
At the time of hospital discharge or death, 69% of patients were classified as having definite meningitis (positive blood or cerebrospinal fluid cultures or positive Gram stain) and 29% were classified as having probable meningitis (bacteria either not detected or cultured, and no alternative diagnosis).
Thirty days after randomization, mortality rates were 10% in the dexamethasone group and 12.4% in the placebo group. The relativ…