Adjuvant medications did not benefit children with meningitis-associated hearing impairment

Administering adjuvant therapy with intravenous dexamethsone, oral glycerol or a combination of both did little to reduce rates of hearing loss among children with bacterial meningitis, study findings suggest.

But researchers believe they have identified important patient characteristics that may help physicians determine a patient’s likelihood of hearing damage.

Researchers from several sites in Europe and South America used the Glasgow coma scale to measure hearing status among 383 children aged 2 months to 6 years presenting with symptoms of bacterial meningitis. Endpoints were a child’s ability to identify sounds of >40dB (indicating impairment), ≥60dB (moderate-to-severe impairment) and ≥80dB (severe impairment) after receiving ceftriaxone (80-100mg/kg once daily, 7-10 days) plus one of the following adjuvant options:

IV dexamethasone (0.15 mg/kg every six hours for 48 hours) and placebo (n=101).
Oral glycerol (1.5 mL/kg every 6 hours for 48 hours; maximum 25 mL for 48 hours) and IV placebo (n=92).
Both agents (n=95).
Placebo only (n=95).

“Neither dexamethasone nor glycerol prevented hearing loss at these levels regardless of the causative agent or timing of antimicrobial agent,” the researchers wrote.

The most common implicated pathogens were Haemophilus influenzae type B (n=146), pneumococcal (n=70) and meningococcal (54) meningitis. Researchers identified seven other types of meningitis and 106 cases remained unidentified.

Despite these findings, the researchers determined that presenting condition and young age were the most important predictors of hearing loss using a multivariate logistic model. They found that risk for hearing impairment increased 15% to 21% with each lowering point on the Glasgow scale for any (OR, 1.20; 95% CI, 1.06-1.35; P=.005), moderate-to-severe (OR, 1.21; 95% CI, 1.07-1.37; P=.003) and severe impairment (OR, 1.15; 95% CI, 1.01-1.31; P=.039).

Inversely, increasing age decreased the risk by 2% to 6% for any (OR, 0.97; 95% CI, 0.96-0.98; P=.0001), moderate-to-severe (OR, 0.96; 95% CI, 0.94-0.98; P=.0007) and severe impairment (OR, 0.98; 95% CI, 0.95-0.99; P=.041).

“Meningitis being caused by Hib, nonreceipt or pretreatment with antimicrobial agents, and the adjuvant started before antimicrobial therapy did not change the results,” the researchers wrote. “To save a child from hearing loss in meningitis, better agents than dexamethasone or glycerol should be sought.”

Peltola H. Pediatrics. 2010;125:e1-e8.