-
Views
-
Cite
Cite
Xavier Sáez-Llorens, George H. McCracken, Reply to Singhi et al., Clinical Infectious Diseases, Volume 47, Issue 5, 1 September 2008, Pages 733–734, https://doi.org/10.1086/590973
Close - Share Icon Share
Extract
To the Editor—;In the concluding paragraph of our commentary regarding the study by Peltola et al. [1], we stated “that the most effective strategy of managing bacterial meningitis and its associated sequelae is prevention by implementing large-scale immunization strategies against the common meningeal pathogens....We urgently need a dedicated collaborative effort between vaccine manufacturers, philanthropic foundations, global health organizations, and national governments to make these vaccines available for those who need them most: the infants and children living in less advantageous areas of the world [2, pp. 1288–9].”
We do not believe that additional discussion of whether dexamethasone or glycerol is more effective as adjunctive therapy for bacterial meningitis in infants and children from very low income nations is a useful exercise. These agents have a relatively small impact in those who are most severely affected, compared with the impact of prevention of disease by vaccination.
Singhi and Singhi [3] took issue with our concern regarding the use of placebo in children with bacterial meningitis in the study by Peltola et al. [1]. They misread our commentary. We questioned the use of placebo for the treatment of meningitis in countries where disease due to Haemophilus influenzae type b (Hib) predominates. This was the case in the Latin American countries included in the study by Peltola et al. [1], in which 221 (45.7%) of 484 patients had meningitis caused by Hib. Stratifying the outcomes for patients with disease due to Hib into dexamethasone versus non-dexamethasone recipients from the Peltola et al. [1] study illustrates our point. Severe neurologic sequelae were observed in 4 (4.5%) of 88 and 9 (9.5%) of 95 patients who received dexamethasone or did not receive dexamethasone (difference is not statistically significant), whereas profound hearing loss was observed in 5 (5.5%) of 91 and 16 (17.8%) of 90 patients (P=.01), respectively. This was likely a concern for 2 institutions in Buenos Aires that decided not to administer the placebo-placebo regimen to their patients who were enrolled in that study [1].
