The records of 97 infants and children with pneumococcal meningitis, 41 receiving corticosteroid therapy, were examined at the Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas. When steroid-therapy was given before or concurrently with antibiotic therapy, none of 30 steroid-treated versus 16 of 52 non-steroid-treated patients developed neurologic or cardiovascular instability after the first parenteral antibiotic dose was given. Bilateral moderate or greater hearing loss occurred in 9% of steroid-treated group compared to 21% of non-steroid group. The incidence of hearing loss was significantly lower in those survivors of overwhelming meningeal infection who had been treated with steroids. [1]

COMMENT. The data from this study were obtained retrospectively and a placebo-controlled double-blind study of dexamethasone in pneumococcal meningitis is indicated. The beneficial effect of corticosteroid adjunctive therapy has been demonstrated previously only in patients with Haemophilus meningitis. Since the incidence of H. influenzae meningitis will be reduced by immunization in the future, S. pneumoniae or N. meningitidis will be the causal agent in a larger percentage of children [2]. Dexamethasone in childhood meningitis is discussed in the correspondence section of this issue of The N Engl J Med. A retrospective evaluation of 12 years experience in the treatment of neonatal meningitis is reported from The Departments of Paediatrics and Bacteriology, Goteborg and Molndal, University of Goteborg, Sweden [3]. Initial treatment with ampicillin-aminoglycoside combination failed in 6 of 34 patients, despite organism sensitivity to the antibiotics.