Despite significant advances in prevention of meningitis through vaccination, and in improved antimicrobial treatment, the disease still kills around 340,000 people worldwide each year.1 Around 75% of these deaths occur in Africa and South East Asia and around 3% in Europe.1 The mortality rate for bacterial meningitis is 10–30% and sequelae, such as cranial nerve impairment, particularly leading to hearing loss, occur in 5–40% of patients.2 Whether adjunctive corticosteroid treatment improves the outcome in bacterial meningitis through an anti-inflammatory effect has been a long-standing controversy. Here we review the role of adjunctive corticosteroids in the management of children (aged over 1 month) and adults with bacterial or tuberculous meningitis.
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