Meningococcemia medical therapy: Difference between revisions
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===Antibiotic Regimen=== | ===Antibiotic Regimen=== | ||
:: '''''For the empirical therapy of meningitis, [[Meningitis medical therapy#Empiric Therapy|click here]]''''' | |||
<SMALL><font color="#FF4C4C">'''▸ Click on the following categories to expand treatment regimens.'''</font><ref name="pmid15494903">Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM et al. (2004) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=15494903 Practice guidelines for the management of bacterial meningitis.] ''Clin Infect Dis'' 39 (9):1267-84. [http://dx.doi.org/10.1086/425368 DOI:10.1086/425368] PMID: [http://pubmed.gov/1549490315494903]</ref><ref name="van de Beek-2012">{{Cite journal | last1 = van de Beek | first1 = D. | last2 = Brouwer | first2 = MC. | last3 = Thwaites | first3 = GE. | last4 = Tunkel | first4 = AR. | title = Advances in treatment of bacterial meningitis. | journal = Lancet | volume = 380 | issue = 9854 | pages = 1693-702 | month = Nov | year = 2012 | doi = 10.1016/S0140-6736(12)61186-6 | PMID = 23141618 }}</ref></SMALL> | <SMALL><font color="#FF4C4C">'''▸ Click on the following categories to expand treatment regimens.'''</font><ref name="pmid15494903">Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM et al. (2004) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=15494903 Practice guidelines for the management of bacterial meningitis.] ''Clin Infect Dis'' 39 (9):1267-84. [http://dx.doi.org/10.1086/425368 DOI:10.1086/425368] PMID: [http://pubmed.gov/1549490315494903]</ref><ref name="van de Beek-2012">{{Cite journal | last1 = van de Beek | first1 = D. | last2 = Brouwer | first2 = MC. | last3 = Thwaites | first3 = GE. | last4 = Tunkel | first4 = AR. | title = Advances in treatment of bacterial meningitis. | journal = Lancet | volume = 380 | issue = 9854 | pages = 1693-702 | month = Nov | year = 2012 | doi = 10.1016/S0140-6736(12)61186-6 | PMID = 23141618 }}</ref></SMALL> | ||
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* Evidences for beneficial effects of [[dexamethasone]] are variable. In some studies, adjunctive use of dexamethasone for bacterial meningitis in selected groups are associated with an improved survival or prognosis.<ref name="Lebel-1988">{{Cite journal | last1 = Lebel | first1 = MH. | last2 = Freij | first2 = BJ. | last3 = Syrogiannopoulos | first3 = GA. | last4 = Chrane | first4 = DF. | last5 = Hoyt | first5 = MJ. | last6 = Stewart | first6 = SM. | last7 = Kennard | first7 = BD. | last8 = Olsen | first8 = KD. | last9 = McCracken | first9 = GH. | title = Dexamethasone therapy for bacterial meningitis. Results of two double-blind, placebo-controlled trials. | journal = N Engl J Med | volume = 319 | issue = 15 | pages = 964-71 | month = Oct | year = 1988 | doi = 10.1056/NEJM198810133191502 | PMID = 3047581 }}</ref><ref name="Odio-1991">{{Cite journal | last1 = Odio | first1 = CM. | last2 = Faingezicht | first2 = I. | last3 = Paris | first3 = M. | last4 = Nassar | first4 = M. | last5 = Baltodano | first5 = A. | last6 = Rogers | first6 = J. | last7 = Sáez-Llorens | first7 = X. | last8 = Olsen | first8 = KD. | last9 = McCracken | first9 = GH. | title = The beneficial effects of early dexamethasone administration in infants and children with bacterial meningitis. | journal = N Engl J Med | volume = 324 | issue = 22 | pages = 1525-31 | month = May | year = 1991 | doi = 10.1056/NEJM199105303242201 | PMID = 2027357 }}</ref><ref name="Thwaites-2004">{{Cite journal | last1 = Thwaites | first1 = GE. | last2 = Nguyen | first2 = DB. | last3 = Nguyen | first3 = HD. | last4 = Hoang | first4 = TQ. | last5 = Do | first5 = TT. | last6 = Nguyen | first6 = TC. | last7 = Nguyen | first7 = QH. | last8 = Nguyen | first8 = TT. | last9 = Nguyen | first9 = NH. | title = Dexamethasone for the treatment of tuberculous meningitis in adolescents and adults. | journal = N Engl J Med | volume = 351 | issue = 17 | pages = 1741-51 | month = Oct | year = 2004 | doi = 10.1056/NEJMoa040573 | PMID = 15496623 }}</ref><ref name="Brouwer-2010">{{Cite journal | last1 = Brouwer | first1 = MC. | last2 = Heckenberg | first2 = SG. | last3 = de Gans | first3 = J. | last4 = Spanjaard | first4 = L. | last5 = Reitsma | first5 = JB. | last6 = van de Beek | first6 = D. | title = Nationwide implementation of adjunctive dexamethasone therapy for pneumococcal meningitis. | journal = Neurology | volume = 75 | issue = 17 | pages = 1533-9 | month = Oct | year = 2010 | doi = 10.1212/WNL.0b013e3181f96297 | PMID = 20881273 }}</ref><ref name="Fritz-2012">{{Cite journal | last1 = Fritz | first1 = D. | last2 = Brouwer | first2 = MC. | last3 = van de Beek | first3 = D. | title = Dexamethasone and long-term survival in bacterial meningitis. | journal = Neurology | volume = 79 | issue = 22 | pages = 2177-9 | month = Nov | year = 2012 | doi = 10.1212/WNL.0b013e31827595f7 | PMID = 23152589 }}</ref><ref name="Peltola-2007">{{Cite journal | last1 = Peltola | first1 = H. | last2 = Roine | first2 = I. | last3 = Fernández | first3 = J. | last4 = Zavala | first4 = I. | last5 = Ayala | first5 = SG. | last6 = Mata | first6 = AG. | last7 = Arbo | first7 = A. | last8 = Bologna | first8 = R. | last9 = Miño | first9 = G. | title = Adjuvant glycerol and/or dexamethasone to improve the outcomes of childhood bacterial meningitis: a prospective, randomized, double-blind, placebo-controlled trial. | journal = Clin Infect Dis | volume = 45 | issue = 10 | pages = 1277-86 | month = Nov | year = 2007 | doi = 10.1086/522534 | PMID = 17968821 }}</ref> However, other studies fail to demonstrate a substantial reduction of death or neurological disability.<ref name="van de Beek-2010">{{Cite journal | last1 = van de Beek | first1 = D. | last2 = Farrar | first2 = JJ. | last3 = de Gans | first3 = J. | last4 = Mai | first4 = NT. | last5 = Molyneux | first5 = EM. | last6 = Peltola | first6 = H. | last7 = Peto | first7 = TE. | last8 = Roine | first8 = I. | last9 = Scarborough | first9 = M. | title = Adjunctive dexamethasone in bacterial meningitis: a meta-analysis of individual patient data. | journal = Lancet Neurol | volume = 9 | issue = 3 | pages = 254-63 | month = Mar | year = 2010 | doi = 10.1016/S1474-4422(10)70023-5 | PMID = 20138011 }}</ref><ref name="Peltola-2010">{{Cite journal | last1 = Peltola | first1 = H. | last2 = Roine | first2 = I. | last3 = Fernández | first3 = J. | last4 = González Mata | first4 = A. | last5 = Zavala | first5 = I. | last6 = Gonzalez Ayala | first6 = S. | last7 = Arbo | first7 = A. | last8 = Bologna | first8 = R. | last9 = Goyo | first9 = J. | title = Hearing impairment in childhood bacterial meningitis is little relieved by dexamethasone or glycerol. | journal = Pediatrics | volume = 125 | issue = 1 | pages = e1-8 | month = Jan | year = 2010 | doi = 10.1542/peds.2009-0395 | PMID = 20008417 }}</ref><ref name="Nguyen-2007">{{Cite journal | last1 = Nguyen | first1 = TH. | last2 = Tran | first2 = TH. | last3 = Thwaites | first3 = G. | last4 = Ly | first4 = VC. | last5 = Dinh | first5 = XS. | last6 = Ho Dang | first6 = TN. | last7 = Dang | first7 = QT. | last8 = Nguyen | first8 = DP. | last9 = Nguyen | first9 = HP. | title = Dexamethasone in Vietnamese adolescents and adults with bacterial meningitis. | journal = N Engl J Med | volume = 357 | issue = 24 | pages = 2431-40 | month = Dec | year = 2007 | doi = 10.1056/NEJMoa070852 | PMID = 18077808 }}</ref><ref name="Molyneux-2002">{{Cite journal | last1 = Molyneux | first1 = EM. | last2 = Walsh | first2 = AL. | last3 = Forsyth | first3 = H. | last4 = Tembo | first4 = M. | last5 = Mwenechanya | first5 = J. | last6 = Kayira | first6 = K. | last7 = Bwanaisa | first7 = L. | last8 = Njobvu | first8 = A. | last9 = Rogerson | first9 = S. | title = Dexamethasone treatment in childhood bacterial meningitis in Malawi: a randomised controlled trial. | journal = Lancet | volume = 360 | issue = 9328 | pages = 211-8 | month = Jul | year = 2002 | doi = | PMID = 12133656 }}</ref> | * Evidences for beneficial effects of [[dexamethasone]] are variable. In some studies, adjunctive use of dexamethasone for bacterial meningitis in selected groups are associated with an improved survival or prognosis.<ref name="Lebel-1988">{{Cite journal | last1 = Lebel | first1 = MH. | last2 = Freij | first2 = BJ. | last3 = Syrogiannopoulos | first3 = GA. | last4 = Chrane | first4 = DF. | last5 = Hoyt | first5 = MJ. | last6 = Stewart | first6 = SM. | last7 = Kennard | first7 = BD. | last8 = Olsen | first8 = KD. | last9 = McCracken | first9 = GH. | title = Dexamethasone therapy for bacterial meningitis. Results of two double-blind, placebo-controlled trials. | journal = N Engl J Med | volume = 319 | issue = 15 | pages = 964-71 | month = Oct | year = 1988 | doi = 10.1056/NEJM198810133191502 | PMID = 3047581 }}</ref><ref name="Odio-1991">{{Cite journal | last1 = Odio | first1 = CM. | last2 = Faingezicht | first2 = I. | last3 = Paris | first3 = M. | last4 = Nassar | first4 = M. | last5 = Baltodano | first5 = A. | last6 = Rogers | first6 = J. | last7 = Sáez-Llorens | first7 = X. | last8 = Olsen | first8 = KD. | last9 = McCracken | first9 = GH. | title = The beneficial effects of early dexamethasone administration in infants and children with bacterial meningitis. | journal = N Engl J Med | volume = 324 | issue = 22 | pages = 1525-31 | month = May | year = 1991 | doi = 10.1056/NEJM199105303242201 | PMID = 2027357 }}</ref><ref name="Thwaites-2004">{{Cite journal | last1 = Thwaites | first1 = GE. | last2 = Nguyen | first2 = DB. | last3 = Nguyen | first3 = HD. | last4 = Hoang | first4 = TQ. | last5 = Do | first5 = TT. | last6 = Nguyen | first6 = TC. | last7 = Nguyen | first7 = QH. | last8 = Nguyen | first8 = TT. | last9 = Nguyen | first9 = NH. | title = Dexamethasone for the treatment of tuberculous meningitis in adolescents and adults. | journal = N Engl J Med | volume = 351 | issue = 17 | pages = 1741-51 | month = Oct | year = 2004 | doi = 10.1056/NEJMoa040573 | PMID = 15496623 }}</ref><ref name="Brouwer-2010">{{Cite journal | last1 = Brouwer | first1 = MC. | last2 = Heckenberg | first2 = SG. | last3 = de Gans | first3 = J. | last4 = Spanjaard | first4 = L. | last5 = Reitsma | first5 = JB. | last6 = van de Beek | first6 = D. | title = Nationwide implementation of adjunctive dexamethasone therapy for pneumococcal meningitis. | journal = Neurology | volume = 75 | issue = 17 | pages = 1533-9 | month = Oct | year = 2010 | doi = 10.1212/WNL.0b013e3181f96297 | PMID = 20881273 }}</ref><ref name="Fritz-2012">{{Cite journal | last1 = Fritz | first1 = D. | last2 = Brouwer | first2 = MC. | last3 = van de Beek | first3 = D. | title = Dexamethasone and long-term survival in bacterial meningitis. | journal = Neurology | volume = 79 | issue = 22 | pages = 2177-9 | month = Nov | year = 2012 | doi = 10.1212/WNL.0b013e31827595f7 | PMID = 23152589 }}</ref><ref name="Peltola-2007">{{Cite journal | last1 = Peltola | first1 = H. | last2 = Roine | first2 = I. | last3 = Fernández | first3 = J. | last4 = Zavala | first4 = I. | last5 = Ayala | first5 = SG. | last6 = Mata | first6 = AG. | last7 = Arbo | first7 = A. | last8 = Bologna | first8 = R. | last9 = Miño | first9 = G. | title = Adjuvant glycerol and/or dexamethasone to improve the outcomes of childhood bacterial meningitis: a prospective, randomized, double-blind, placebo-controlled trial. | journal = Clin Infect Dis | volume = 45 | issue = 10 | pages = 1277-86 | month = Nov | year = 2007 | doi = 10.1086/522534 | PMID = 17968821 }}</ref> However, other studies fail to demonstrate a substantial reduction of death or neurological disability.<ref name="van de Beek-2010">{{Cite journal | last1 = van de Beek | first1 = D. | last2 = Farrar | first2 = JJ. | last3 = de Gans | first3 = J. | last4 = Mai | first4 = NT. | last5 = Molyneux | first5 = EM. | last6 = Peltola | first6 = H. | last7 = Peto | first7 = TE. | last8 = Roine | first8 = I. | last9 = Scarborough | first9 = M. | title = Adjunctive dexamethasone in bacterial meningitis: a meta-analysis of individual patient data. | journal = Lancet Neurol | volume = 9 | issue = 3 | pages = 254-63 | month = Mar | year = 2010 | doi = 10.1016/S1474-4422(10)70023-5 | PMID = 20138011 }}</ref><ref name="Peltola-2010">{{Cite journal | last1 = Peltola | first1 = H. | last2 = Roine | first2 = I. | last3 = Fernández | first3 = J. | last4 = González Mata | first4 = A. | last5 = Zavala | first5 = I. | last6 = Gonzalez Ayala | first6 = S. | last7 = Arbo | first7 = A. | last8 = Bologna | first8 = R. | last9 = Goyo | first9 = J. | title = Hearing impairment in childhood bacterial meningitis is little relieved by dexamethasone or glycerol. | journal = Pediatrics | volume = 125 | issue = 1 | pages = e1-8 | month = Jan | year = 2010 | doi = 10.1542/peds.2009-0395 | PMID = 20008417 }}</ref><ref name="Nguyen-2007">{{Cite journal | last1 = Nguyen | first1 = TH. | last2 = Tran | first2 = TH. | last3 = Thwaites | first3 = G. | last4 = Ly | first4 = VC. | last5 = Dinh | first5 = XS. | last6 = Ho Dang | first6 = TN. | last7 = Dang | first7 = QT. | last8 = Nguyen | first8 = DP. | last9 = Nguyen | first9 = HP. | title = Dexamethasone in Vietnamese adolescents and adults with bacterial meningitis. | journal = N Engl J Med | volume = 357 | issue = 24 | pages = 2431-40 | month = Dec | year = 2007 | doi = 10.1056/NEJMoa070852 | PMID = 18077808 }}</ref><ref name="Molyneux-2002">{{Cite journal | last1 = Molyneux | first1 = EM. | last2 = Walsh | first2 = AL. | last3 = Forsyth | first3 = H. | last4 = Tembo | first4 = M. | last5 = Mwenechanya | first5 = J. | last6 = Kayira | first6 = K. | last7 = Bwanaisa | first7 = L. | last8 = Njobvu | first8 = A. | last9 = Rogerson | first9 = S. | title = Dexamethasone treatment in childhood bacterial meningitis in Malawi: a randomised controlled trial. | journal = Lancet | volume = 360 | issue = 9328 | pages = 211-8 | month = Jul | year = 2002 | doi = | PMID = 12133656 }}</ref> | ||
* [[Dexamethasone]] should not be given to patients who have already received animicrobial therapy because it is unlikely to improve clinical outcome.<ref name="pmid15494903">Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM et al. (2004) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=15494903 Practice guidelines for the management of bacterial meningitis.] ''Clin Infect Dis'' 39 (9):1267-84. [http://dx.doi.org/10.1086/425368 DOI:10.1086/425368] PMID: [http://pubmed.gov/15494903 15494903]</ref> | * [[Dexamethasone]] should not be given to patients who have already received animicrobial therapy because it is unlikely to improve clinical outcome.<ref name="pmid15494903">Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM et al. (2004) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=15494903 Practice guidelines for the management of bacterial meningitis.] ''Clin Infect Dis'' 39 (9):1267-84. [http://dx.doi.org/10.1086/425368 DOI:10.1086/425368] PMID: [http://pubmed.gov/15494903 15494903]</ref> | ||
==References== | ==References== | ||
Revision as of 21:07, 1 December 2014
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Meningococcemia Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Meningococcemia medical therapy On the Web |
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American Roentgen Ray Society Images of Meningococcemia medical therapy |
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Risk calculators and risk factors for Meningococcemia medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [3]; Ammu Susheela, M.D. [4]; Alejandro Lemor, M.D. [5]
Overview
Meningococcemia is a medical emergency. Breathing support, fluid resucitation, antibiotics like cephalosporin and wound care are the major aspects of treatment.
Medical Therapy
- Meningococcemia is a medical emergency. Patients with this type of infection are often admitted to the intensive care unit of the hospital, where they are closely monitored.
- The patient may be placed in respiratory isolation for the first 24 hours to help prevent the spread of the infection to others.
- Meningococcal disease can be treated with a number of effective antibiotics.
- It is important that treatment be started as soon as possible. If meningococcal disease is suspected, antibiotics are given right away. Antibiotic treatment should reduce the risk of dying, but sometimes the infection has caused too much damage to the body for antibiotics to prevent death or serious long-term problems.
- Even with antibiotic treatment, people die in about 10-15% of cases. About 11-19% of survivors will have long-term disabilities, such as loss of limb(s), deafness, nervous system problems, or brain damage.
- Depending on how serious the infection is, other treatments may also be necessary. These can include such things as breathing support, medications to treat low blood pressure, and wound care for parts of the body with damaged skin.[1]
Antibiotic Regimen
- For the empirical therapy of meningitis, click here
▸ Click on the following categories to expand treatment regimens.[2][3]
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N. meningitidis ▸ Penicillin MIC <0.1 μg/mL ▸ Penicillin MIC ≥0.1 μg/mL |
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- The duration of therapy should be 7 days. However, the duration of antimicrobial therapy should be individualized in accordance with patient's clinical response.
- Evidences for beneficial effects of dexamethasone are variable. In some studies, adjunctive use of dexamethasone for bacterial meningitis in selected groups are associated with an improved survival or prognosis.[4][5][6][7][8][9] However, other studies fail to demonstrate a substantial reduction of death or neurological disability.[10][11][12][13]
- Dexamethasone should not be given to patients who have already received animicrobial therapy because it is unlikely to improve clinical outcome.[2]
References
- ↑ "The Centers for Disease Control and Prevention(CDC)".
- ↑ 2.0 2.1 Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM et al. (2004) Practice guidelines for the management of bacterial meningitis. Clin Infect Dis 39 (9):1267-84. DOI:10.1086/425368 PMID: [1]
- ↑ van de Beek, D.; Brouwer, MC.; Thwaites, GE.; Tunkel, AR. (2012). "Advances in treatment of bacterial meningitis". Lancet. 380 (9854): 1693–702. doi:10.1016/S0140-6736(12)61186-6. PMID 23141618. Unknown parameter
|month=ignored (help) - ↑ Lebel, MH.; Freij, BJ.; Syrogiannopoulos, GA.; Chrane, DF.; Hoyt, MJ.; Stewart, SM.; Kennard, BD.; Olsen, KD.; McCracken, GH. (1988). "Dexamethasone therapy for bacterial meningitis. Results of two double-blind, placebo-controlled trials". N Engl J Med. 319 (15): 964–71. doi:10.1056/NEJM198810133191502. PMID 3047581. Unknown parameter
|month=ignored (help) - ↑ Odio, CM.; Faingezicht, I.; Paris, M.; Nassar, M.; Baltodano, A.; Rogers, J.; Sáez-Llorens, X.; Olsen, KD.; McCracken, GH. (1991). "The beneficial effects of early dexamethasone administration in infants and children with bacterial meningitis". N Engl J Med. 324 (22): 1525–31. doi:10.1056/NEJM199105303242201. PMID 2027357. Unknown parameter
|month=ignored (help) - ↑ Thwaites, GE.; Nguyen, DB.; Nguyen, HD.; Hoang, TQ.; Do, TT.; Nguyen, TC.; Nguyen, QH.; Nguyen, TT.; Nguyen, NH. (2004). "Dexamethasone for the treatment of tuberculous meningitis in adolescents and adults". N Engl J Med. 351 (17): 1741–51. doi:10.1056/NEJMoa040573. PMID 15496623. Unknown parameter
|month=ignored (help) - ↑ Brouwer, MC.; Heckenberg, SG.; de Gans, J.; Spanjaard, L.; Reitsma, JB.; van de Beek, D. (2010). "Nationwide implementation of adjunctive dexamethasone therapy for pneumococcal meningitis". Neurology. 75 (17): 1533–9. doi:10.1212/WNL.0b013e3181f96297. PMID 20881273. Unknown parameter
|month=ignored (help) - ↑ Fritz, D.; Brouwer, MC.; van de Beek, D. (2012). "Dexamethasone and long-term survival in bacterial meningitis". Neurology. 79 (22): 2177–9. doi:10.1212/WNL.0b013e31827595f7. PMID 23152589. Unknown parameter
|month=ignored (help) - ↑ Peltola, H.; Roine, I.; Fernández, J.; Zavala, I.; Ayala, SG.; Mata, AG.; Arbo, A.; Bologna, R.; Miño, G. (2007). "Adjuvant glycerol and/or dexamethasone to improve the outcomes of childhood bacterial meningitis: a prospective, randomized, double-blind, placebo-controlled trial". Clin Infect Dis. 45 (10): 1277–86. doi:10.1086/522534. PMID 17968821. Unknown parameter
|month=ignored (help) - ↑ van de Beek, D.; Farrar, JJ.; de Gans, J.; Mai, NT.; Molyneux, EM.; Peltola, H.; Peto, TE.; Roine, I.; Scarborough, M. (2010). "Adjunctive dexamethasone in bacterial meningitis: a meta-analysis of individual patient data". Lancet Neurol. 9 (3): 254–63. doi:10.1016/S1474-4422(10)70023-5. PMID 20138011. Unknown parameter
|month=ignored (help) - ↑ Peltola, H.; Roine, I.; Fernández, J.; González Mata, A.; Zavala, I.; Gonzalez Ayala, S.; Arbo, A.; Bologna, R.; Goyo, J. (2010). "Hearing impairment in childhood bacterial meningitis is little relieved by dexamethasone or glycerol". Pediatrics. 125 (1): e1–8. doi:10.1542/peds.2009-0395. PMID 20008417. Unknown parameter
|month=ignored (help) - ↑ Nguyen, TH.; Tran, TH.; Thwaites, G.; Ly, VC.; Dinh, XS.; Ho Dang, TN.; Dang, QT.; Nguyen, DP.; Nguyen, HP. (2007). "Dexamethasone in Vietnamese adolescents and adults with bacterial meningitis". N Engl J Med. 357 (24): 2431–40. doi:10.1056/NEJMoa070852. PMID 18077808. Unknown parameter
|month=ignored (help) - ↑ Molyneux, EM.; Walsh, AL.; Forsyth, H.; Tembo, M.; Mwenechanya, J.; Kayira, K.; Bwanaisa, L.; Njobvu, A.; Rogerson, S. (2002). "Dexamethasone treatment in childhood bacterial meningitis in Malawi: a randomised controlled trial". Lancet. 360 (9328): 211–8. PMID 12133656. Unknown parameter
|month=ignored (help)