"The way I would want people to use our study is not to say there does not seem to be a benefit, or that [corticosteroids] should be used routinely, but to regard it as an impetus for a large, randomized trial," Shah said. "At this point, it would seem that the benefits do not outweigh the risks of using corticosteroids in children, but we need a large-scale clinical trial looking at neurological damage before deciding yes or no."
The study had another flaw, said Dr. Robert W. Frenck, a professor of pediatrics in the division of infectious diseases at Cincinnati Children's Hospital Medical Center: It did not include information on when in the course of the infection corticosteroids were given.
"A number of studies with animals and humans have shown that using corticosteroids before the first dose of antibiotics has the most benefit," Frenck said. "It reduces the inflammatory response that results when the immune system kills the bacteria."
Physicians who treat meningitis are likely to say that the study supports whatever they are now doing, he said. "If people are in the camp where corticosteroids are not regarded as helpful, they will say this shows that they don't help," Frenck said. "If they are in the camp where they are seen as beneficial, they will say that the study does not disprove it."
The large-scale trial proposed by Shah is not likely to happen, Frenck said, and for a cheerful reason -- the very low incidence of bacterial meningitis among American children. Vaccines against the bacteria that cause meningitis, such as Hemophilus influenzae type B, have successfully reduced the incidence of the disease, Frenck said. For that reason, bacterial meningitis now occurs in about eight in every 100,000 American children.
"The vaccines have had a tremendous effect
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