Dexamethasone (.15 mg/kg/bwt q 6 hr for 4 days) was considered beneficial in the treatment of infants and children with bacterial meningitis, particularly in preventing deafness, in two double blind, placebo-controlled trials involving 200 patients treated in the Dept of Pediatrics, University of Texas at Southwestern Medical Center, Dallas, TX. As compared to 98 patients receiving placebo, 102 treated with dexamethasone became afebrile earlier (1.6 vs 5 days;P<.001) and were less likely to acquire bilateral sensorineural hearing loss (15.5 vs 3.3%; P<.01). Twelve patients in the 2 placebo groups (14%) had severe bilateral loss as compared with 1(1%)) in the 2 dexamethasone groups (P<.001). 
COMMENT. An editorial in the same issue  applauds the investigators for undertaking a difficult and complex study but notes that enthusiasm for the findings is dampened by the lack of follow-up of all patients enrolled in the study. The patients may have been restudied too early to detect improvement in auditory acuity of controls, and the dexamethasone group may have been less severely ill than the controls. An assessment of higher cortical function one year after discharge revealed no significant difference in treatment and control groups. Dexamethasone in the treatment of a severely ill child with meningitis may be recommended but a confirmatory study documenting safety is advised to determine its necessity in mild cases. Dexamethasone may save the hearing but worsen cerebal cortical function by ischemic injury and may induce gastrointestinal bleeding.