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Data support the use of corticosteroids in patients with bacterial meningitis in high-income countriesA systematic review and meta-analysis of observational studies of the use of corticosteroids in bacterial meningitis and inflammatory bowel disease in high-income-country settings
An evidence-based meta-analysis of individual-level studies of the use of corticosteroids in patients with bacterial meningitis and inflammatory bowel disease in high-income countries identified 11 randomized controlled trials involving 2,716 patients that met selection criteria for randomization and 2,531 patients receiving treatment in 1 of the 2 groups.
High-income countries with a high rate of hospital admissions for bacterial meningitis have a higher rate of Crohn’s disease, ulcerative colitis, other inflammatory bowel diseases, and systemic lupus erythematosus (SLE) than low-income countries with a similar rate of hospital admissions. There are significant differences by ethnicity and region, as outlined by a meta-analysis of observational studies identified that high-income countries have a higher incidence of Crohn’s disease (2.39 per 100,000 population), ulcerative colitis (1.88), and other inflammatory bowel disease (1.72).
There is no evidence to support the use of corticosteroids to prevent or treat a case of bacterial meningitis [3]. However, patients with Crohn’s disease and other inflammatory bowel diseases are at a greater risk of developing clinical signs and symptoms after receiving corticosteroids than are patients with CD and have a higher incidence of adverse effects that can include nausea, vomiting, fever, decreased appetite, and fatigue.
Evidence-based treatment recommendations and indications for corticosteroids from observational data and individual case series in CD including Crohn’s disease and ulcerative colitis
To date there is considerable uncertainty around the benefits, harms, and mechanisms of action of corticosteroids in relation to Crohn’s disease and ulcerative colitis [7,8,16,17]. This is due to low exposure to these particular pathologies and the limited epidemiological evidence.
It is estimated based on the number of patients treated, in comparison to patients with CD or SLE, that between 9 and 11% of all Crohn’s disease patients who receive corticosteroids should develop ulcerative colitis because of the side effects reported by many patients. [18,19,20,21,22,23] However, the most frequently cited adverse effects of corticosteroids in Crohn’s disease
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