Despite the presence of meta-analyzes, there is currently no clinical trial with an individual evaluation of the results of the disease, confirming the feasibility of using dexamethasone as an additional treatment for bacterial meningitis in children who are prescribed third generation cephalosporins.

In Latin America, a prospective, randomized, double-blind study was conducted comparing the use of dexamethasone as an adjunct or glycerol versus placebo in children aged 2 months to 16 years. All of the children who were prescribed ceftriaxone were, in turn, randomized into 4 groups: receiving dexamethasone iv, oral glycerin, both drugs, or receiving no additional treatment. The main outcome measures for this study were to determine death rates, the incidence of serious neurological complications, or the development of deafness. A subgroup analysis was also performed separately in children with bacterial meningitis caused by Haemophilus influenzae type b.

The main pathogens isolated from 654 patients were H. influenzae type b, pneumococci and meningococci. Dexamethasone was administered to 166 children, dexamethasone and glycerin - 159, glycerin - 166 and placebo - 163. Additional treatment did not significantly affect mortality or deafness. At the same time, glycerol and the combination of dexamethasone with glycerin reduced the incidence of serious neurological complications compared to placebo; the odds ratio was 0.31 (95% CI 0.13-0.76; p = 0.010) and 0.39 (95% CI 0.17-0.93; p = 0.033), respectively. For neurological complications and mortality, when comparing the same groups, the odds ratio was 0.44 (95% CI 0.25-0.76; p = 0.003) and 0.55 (CI 95% 0.32-0.93; p = 0.027), respectively. Dexamethasone treatment prevented deafness in children with bacterial meningitis caused by Haemophilus influenzae type b only if the time between the administration of dexamethasone and ceftriaxone was not not taken into account (OR 0.27; 95% CI 0.09-0.77; p = 0.014).

Thus, the administration of glycerol indoors to children with bacterial meningitis prevents the development of severe neurological complications. The benefits of using this medication include safety, affordability, low cost and the route of oral administration.