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2016 ; 21
(ä): 22
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Meta-analysis of studies comparing adjuvant dexamethasone to glycerol to improve
clinical outcome of bacterial meningitis
#MMPMID27904568
Vaziri S
; Mansouri F
; Sayad B
; Ghadiri K
; Torkashvand E
; Rezaei M
; Najafi F
; Azizi M
J Res Med Sci
2016[]; 21
(ä): 22
PMID27904568
show ga
BACKGROUND: Neurological complications are a problematic factor in acute
bacterial meningitis; hence, its prevention is the key to ensure the success of
meningitis treatment. Glycerol and dexamethasone are both applied in this regard.
Oral glycerol is an appropriate alternative instead of intravenous dexamethasone
because it does not have problems related to intravenous injection, the high
cost, and drug complications. The main objective of this study was to compare the
efficacy of adjuvant dexamethasone versus glycerol in order to improve the
clinical outcome of bacterial meningitis. MATERIALS AND METHODS: We conducted a
search on the available resources including PubMed, Ovid, Elsevier, Cochrane, and
another search engines such as Google till 2014. All clinical trials that were
performed in the field of comparing the effectiveness of the two drugs and met
the inclusion criteria were gathered and after extraction the relative risk (RR)
values, the pooled RR was calculated. The main outcome was neurological
complications. Meta-analysis of the data was performed in Stata version 11.2
using both fixed and random effect models, weighting each study by inverse of
variance. RESULTS: In 5 comparative studies (1,340 patients), the rate of
neurological complications of glycerol compared to that of dexamethasone was 1.02
[95% confidence interval (CI), 0.98 compared to 1.12]. The rate of neurological
complications of dexamethasone compared to dexamethasone + glycerol was 1 (95%
CI, 0.97 compared to 1.03), dexamethasone compared to placebo was 0.99 (95% CI,
0.97 compared to 1.03), glycerol compared to glycerol + dexamethasone was 0.98
(95% CI, 0.94 compared to 1.02), and glycerol compared to placebo was 0.97 (95%
CI, 0.94 compared to 1.01). In these studies, no difference was reported between
dexamethasone and glycerol in terms of reducing neurological complications.
CONCLUSION: Although there were some weak evidences for the nonstatistical
significant effect of glycerol in the prevention of neurologic complication after
meningitis, there was no difference between glycerol and dexamethasone.