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Clinical Review Lesson of the week

Acute obstructive hydrocephalus complicating bacterial meningitis in childhood

BMJ 1998; 316 doi: (Published 20 June 1998) Cite this as: BMJ 1998;316:1887

Rapid Response:

Dexamthasone and Streptococcus pneumoniae meningitis.

Mactier et al illustrate an important complication of bacterial meningitis, namely acute obstructive hydrocephalus[1].

The authors say that they "could not find any record of the incidence of this complication" in children. There is a report of a series from Australia over a 11 year period where there was an incidence of 2.8% of 79 cases[2].

Interestingly, the first case did not receive dexamethasone, whereas the second case did. There is no mention in the latter case when the drug was commenced or its role in treating the aforementioned complication. The use of the drug remains contentious. A recent meta-analysis showed that if it is commenced with or before parenteral antibiotics, there is benefit in pneumococcal meningitis[3]. Clearly the use of dexamethasone in this context requires further research.

[1]. Mactier H, Galea P, McWilliam R. Lesson of the week. Acute obstructive hydrocephalus complicating bacterial meningitis in Childhood. BMJ 1998;316:1887-9

[2]. Thomas DG. Outcome of paediatric bacterial meningitis 1979-1989. Med J Aust 1992 Oct 19;157(8):519-520

[3]. McIntyre PB, Berkey CS, King SM, Schaad UB, Kilpi T, Kanra GY, Perez CM. Dexamethasone as adjunctive therapy in bacterial meningitis. A meta-analysis of randomized clinical trials since 1988. JAMA 1997 Sep 17;278(11):925-931

Competing interests: No competing interests

29 June 1998
Asrar Rashid
Clinical Fellow
New South Wales newborn and paediatric Emergency Transport Service