Adjunctive Corticosteroids in Pediatric Meningitis: Current Evidence, Clinical Controversies, and Future Directions.
- 1Pediatric Clinic, Department of Medicine and Surgery, University Hospital of Parma, 43126 Parma, Italy.
Abstract
Background: Pediatric bacterial meningitis remains an important cause of death and long-term neurological disability despite advances in vaccination, antimicrobial therapy, and supportive care. Because host inflammation contributes substantially to secondary neuronal injury, adjunctive corticosteroids have been investigated as a strategy to reduce inflammation-mediated complications. This narrative review aims to critically evaluate the current evidence on corticosteroid therapy in pediatric meningitis, with particular emphasis on acute bacterial meningitis, major clinical and neurological outcomes, treatment timing, pathogen-specific effects, and the impact of changing post-vaccination epidemiology. Methods: A structured search of PubMed/MEDLINE, Scopus, and Web of Science was conducted for relevant publications available up to June 2026. Randomized controlled trials, observational studies, systematic reviews, meta-analyses, and international guidelines involving patients aged 0-18 years were considered. Evidence was synthesized narratively, focusing on mortality, hearing loss, neurological sequelae, long-term outcomes, safety, causative pathogen, and timing of corticosteroid administration. Results: Adjunctive dexamethasone has not demonstrated a consistent mortality benefit, while evidence concerning hospital stay, intensive care utilization, and healthcare costs remains limited. Its most reproducible benefit is a reduction in sensorineural hearing loss, particularly in Haemophilus influenzae type b (Hib) meningitis. Benefits in pneumococcal meningitis are less consistent, and evidence supporting routine use in meningococcal disease remains limited. Efficacy appears greatest when dexamethasone is administered before or with the first antibiotic dose and may be less pronounced in the post-vaccination era. In tuberculous meningitis, corticosteroids improve survival, whereas routine use is not supported in uncomplicated viral meningitis or cryptococcal meningitis. Conclusions: Adjunctive dexamethasone should be used selectively in pediatric meningitis, with its clearest benefit being hearing preservation in early-treated Hib meningitis. Treatment decisions should account for pathogen, timing, and epidemiological context.
Related
- The hormone–microbiota–NET framework in gynecologic diseases: evidence, controversies, and translational opportunities
- Engagement in food system-related controversies can strengthen science–policy–society interfaces
- Phage intervention improves colitis and response to corticosteroids by attenuating virulence of Crohn’s disease–associated bacteria
- Controversies and consensus on immune function and long-term health risks following adult thymectomy: a comprehensive review of molecular mechanisms and real-world evidence
- SOS-independent prophage induction pathways and their contributions to antibiotic resistance gene dissemination: advances and controversies
BibTeX
@article{zambelli2026adjunctive,
title = {{Adjunctive Corticosteroids in Pediatric Meningitis: Current Evidence, Clinical Controversies, and Future Directions.}},
author = {Giulia Zambelli and Marco Masetti and Sonia Diona and Lorenzo Bonacorsi and Irene Addati and Susanna Esposito},
journal = {Pharmaceuticals (Basel, Switzerland)},
year = {2026},
month = oct,
doi = {10.3390/ph19101563},
url = {https://europepmc.org/article/MED/42943260},
note = {CC BY},
}
RIS
TY - JOUR
TI - Adjunctive Corticosteroids in Pediatric Meningitis: Current Evidence, Clinical Controversies, and Future Directions.
AU - Giulia Zambelli
AU - Marco Masetti
AU - Sonia Diona
AU - Lorenzo Bonacorsi
AU - Irene Addati
AU - Susanna Esposito
PY - 2026
DA - 2026/10/01
JO - Pharmaceuticals (Basel, Switzerland)
DO - 10.3390/ph19101563
UR - https://europepmc.org/article/MED/42943260
AB - Background: Pediatric bacterial meningitis remains an important cause of death and long-term neurological disability despite advances in vaccination, antimicrobial therapy, and supportive care. Because host inflammation contributes substantially to secondary neuronal injury, adjunctive corticosteroids have been investigated as a strategy to reduce inflammation-mediated complications. This narrative review aims to critically evaluate the current evidence on corticosteroid therapy in pediatric meningitis, with particular emphasis on acute bacterial meningitis, major clinical and neurological outcomes, treatment timing, pathogen-specific effects, and the impact of changing post-vaccination epidemiology. Methods: A structured search of PubMed/MEDLINE, Scopus, and Web of Science was conducted for relevant publications available up to June 2026. Randomized controlled trials, observational studies, systematic reviews, meta-analyses, and international guidelines involving patients aged 0-18 years were considered. Evidence was synthesized narratively, focusing on mortality, hearing loss, neurological sequelae, long-term outcomes, safety, causative pathogen, and timing of corticosteroid administration. Results: Adjunctive dexamethasone has not demonstrated a consistent mortality benefit, while evidence concerning hospital stay, intensive care utilization, and healthcare costs remains limited. Its most reproducible benefit is a reduction in sensorineural hearing loss, particularly in Haemophilus influenzae type b (Hib) meningitis. Benefits in pneumococcal meningitis are less consistent, and evidence supporting routine use in meningococcal disease remains limited. Efficacy appears greatest when dexamethasone is administered before or with the first antibiotic dose and may be less pronounced in the post-vaccination era. In tuberculous meningitis, corticosteroids improve survival, whereas routine use is not supported in uncomplicated viral meningitis or cryptococcal meningitis. Conclusions: Adjunctive dexamethasone should be used selectively in pediatric meningitis, with its clearest benefit being hearing preservation in early-treated Hib meningitis. Treatment decisions should account for pathogen, timing, and epidemiological context.
SN - 1424-8247
ER -