***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Thirty patients of bacterial meningitis ( age > 12 years ) were r and omised into two treatment groups . Group I ( n=14 ) received intravenous dexamethasone with antibiotics and group II (n=16)received  only antibiotics . Baseline demographic , clinical and laboratory features of the two groups were similar . Four patients died , three in control group and one in dexamethasone group ( p=0.60 ) . Focal neurological deficits at discharge were found in three patients receiving dexamethasone and two in control group ( p=0.64 ) . Audiological sequelae were found in seven ( 23 ) patients , four in group I and three in group II ( p = 1.00 ) but there were no statistically significant differences between the two groups . No steroid side effects were noted . In the present study , dexamethasone treatment was not found to significantly improve survival but sample size was too small to reliably exclude clinical ly important benefit of dexamethasone . Larger r and omised controlled studies in adult population are needed to reliably estimate the effects of dexamethasone as adjunctive therapy in acute bacterial meningitis in adults Background Dexamethasone has been shown to reduce mortality in patients with tuberculous meningitis but the long-term outcome of the disease is unknown . Methods Vietnamese adults and adolescents with tuberculous meningitis recruited to a r and omised , double-blind , placebo-controlled trial of adjunctive dexamethasone were followed-up at five years , to determine the effect of dexamethasone on long-term survival and neurological disability . Results 545 patients were r and omised to receive either  dexamethasone  ( 274 patients ) or  placebo  ( 271 patients ) . 50 patients ( 9.2 % ) were lost to follow-up at five years . In all patients two-year survival , probabilities tended to be higher in the dexamethasone arm ( 0.63 versus 0.55 ; p = 0.07 ) but five-year survival rates were similar ( 0.54 versus 0.51 , p = 0.51 ) in both groups . In patients with grade 1 TBM , but not with grade 2 or grade 3 TBM , the benefit of dexamethasone treatment tended to persist over time ( five-year survival probabilities 0.69 versus 0.55 , p = 0.07 ) but there was no conclusive evidence of treatment effect heterogeneity by TBM grade ( p = 0.36 ) . The dexamethasone group had a similar proportion of severely disabled patients among survivors at five years as the placebo group ( 17/128 , 13.2 % vs. 17/116 , 14.7 % ) and there was no significant association between dexamethasone treatment and disability status at five years ( p = 0.32 ) . Conclusions Adjunctive dexamethasone appears to improve the probability of survival in patients with TBM , until at least two years of follow-up . We could not demonstrate a five-year survival benefit of dexamethasone treatment which may be confined to patients with grade 1 TBM . Trial Registration Clinical Trials.gov NCT01317654 NCT01317654?term = tuberculous+meningitis&rank = To which groups of patients can the results of clinical trials be applied ? This question is often inappropriately answered by reference to the trial entry criteria . Instead , the benefit and harm ( adverse events , discomfort of treatment , etc ) of treatment could be assessed separately for individual patients . Patients at greatest risk of a disease will have the greatest net benefit as benefit to patients usually increases with risk while harm remains comparatively fixed . To assess net benefit , the relative risks should come from ( a meta- analysis of ) r and omised trials ; the risk in individual patients should come from multivariate risk equations derived from cohort studies . However , before making firm conclusions , the assumptions of fixed adverse effects and constant reduction in relative risk need to be checked This study was conducted on 77 Libyan infants and children aged month to 10 years with acute bacterial meningitis . Upon admission , the patients were divided r and omly in two groups . Group I ( 38 patients ) received ceftriaxone plus dexamethasone I.V. Group II ( 39 patients ) received ceftriaxone alone . Both groups were compared for mean changes in CSF sugar , CSF protein and CSF polymorph count at 4th day of treatment . There was a significant difference between the two groups in CSF sugar and protein changes ( P < 0.05 ) but not in CSF polymorph ( P > 0.05).Both groups showed prompt clinical response and similar occurrence of acute complications , fatality rate and permanent neurological sequelae . However , group I manifested shorter duration of fever ( P < 0.05 ) . Dexamethasone improved the inflammatory reaction in acute bacterial meningitis and shortened the duration of fever but it did not have any significant effect on the fatality and the occurrence of neurological sequelae of this disease BACKGROUND In sub-Saharan Africa , bacterial meningitis is common and is associated with a high mortality .  Adjuvant therapy with corticosteroids reduces mortality among adults in the developed world , but it has not been adequately tested in developing countries or in the context of advanced human immunodeficiency virus ( HIV ) infection . METHODS We conducted a r and omized , double-blind , placebo-controlled trial of dexamethasone ( 16 mg twice daily for 4 days ) and an open-label trial of intramuscular versus intravenous ceftriaxone ( 2 g twice daily for 10 days ) in adults with an admission diagnosis of bacterial meningitis in Blantyre , Malawi . The primary outcome was death at 40 days after r and omization . RESULTS A total of 465 patients , 90 % of whom were HIV-positive , were r and omly assigned to receive dexamethasone ( 233 patients ) or placebo ( 232 patients ) plus intramuscular ceftriaxone ( 230 patients ) or intravenous ceftriaxone ( 235 patients ) . There was no significant difference in mortality at 40 days in the corticosteroid group ( 129 of 231 patients ) as compared with the placebo group ( 120 of 228 patients ) by intention-to-treat analysis ( odds ratio , 1.14 ; 95 % confidence interval [ CI ] , 0.79 to 1.64 ) or when the analysis was restricted to patients with proven pneumococcal meningitis ( 68 of 129 patients receiving corticosteroids vs. 72 of 143 patients receiving placebo ) ( odds ratio , 1.10 ; 95 % CI , 0.68 to 1.77 ) . There were no significant differences between groups in the outcomes of disability and death combined , hearing impairment , and adverse events . There was no difference in mortality with intravenous ceftriaxone ( 121 of 230 patients ) as compared with intramuscular ceftriaxone ( 128 of 229 patients ) ( odds ratio , 0.88 ; 95 % CI , 0.61 to 1.27 ) . CONCLUSIONS Adjuvant therapy with dexamethasone for bacterial meningitis in adults from an area with a high prevalence of HIV did not reduce mortality or morbidity . In this setting , intramuscular administration was not inferior to intravenous administration of ceftriaxone for bacterial meningitis . ( Current Controlled Trials number , IS RCT N31371499 [ controlled-trials.com ] . ) A multicentre r and omized controlled trial was conducted in children with bacterial meningitis using dexamethasone or placebo for four days within 24 h of starting antibiotics . Primary outcomes were hearing loss and neurological abnormalities at 12 months after meningitis . The dexamethasone ( n=50 ) and placebo ( n=51 ) groups were similar in age , severity of illness and etiological agent . Hearing loss occurred in 10 % and 11 % of the dexamethasone and placebo groups and neurological deficits occurred in 20 % and 18 % of patients , respectively . Duodenal perforation occurred in one dexamethasone-treated child . In conclusion , there was no significant benefit in those receiving dexamethasone . The lack of benefit may have been due to the delay in administration of dexamethasone ( median delay of 11 h after antibiotics ) . Therefore , if dexamethasone is used for meningitis it should be given immediately with the antibiotic OBJECTIVE To determine whether treatment with dexamethasone and ceftriaxone for children with bacterial meningitis reduces the frequency of either sensorineural hearing loss or other neurologic sequelae . DESIGN This was a prospect i ve , multicentered , placebo-controlled clinical trial . Subjects were followed for 1 year . SETTING The study was conducted in six children 's hospitals located in Pittsburgh , Houston , Los Angeles , Chicago , Washington , D.C. , and Columbus , Ohio . PATIENTS Enrolled were 173 children , 8 weeks to 12 years of age , with suspected bacterial meningitis ; 143 children were evaluable . Eighty-seven percent of patients were followed for at least 6 weeks to 3 months , and 67 % were followed for 1 year . INTERVENTIONS Subjects were r and omized to receive ceftriaxone with or without dexamethasone ( 0.15 mg/kg every 6 hours for 4 days ) .  Auditory brainstem responses ( ABR )  were measured within 24 hours of admission . MAIN OUTCOME MEASURES Hearing , development , and neurologic sequelae were assessed at the time of discharge and 6 weeks and 1 year later . MAIN RESULTS One hundred forty-three patients ( 69 received dexamethasone and 74 received placebo ) with bacterial meningitis were evaluable : Haemophilus influenzae type b ( 83 ) , Streptococcus pneumoniae ( 33 ) , Neisseria meningitidis ( 24 ) , and three others . Overall , there was no significant difference in auditory outcome between dexamethasone and placebo recipients . Twenty-two children had bilateral moderate or more severe hearing loss at the time of the first ABR . At follow-up , the resolution of hearing impairment was nearly identical for each group . Nine of ten children who remained persistently deaf were deaf at the time of the first ABR . There were no differences in neurologic or developmental outcome between groups . CONCLUSION All but one child with persistent bilateral moderate or more severe hearing loss had demonstrable deafness at the time of the first ABR . Dexamethasone did not significantly improve audiologic , neurologic , or developmental outcome in children with bacterial meningitis OBJECTIVE To evaluate the efficacy of dexamethasone added to the treatment of adult patients with bacterial meningitis in our region . METHODS One hundred and forty-four patients were r and omized prospect ively and evaluated to determine the efficacy of dexamethasone treatment in adult patients with acute bacterial meningitis at Dicle University Hospital , Diyarbakir , Turkey between January 2000 and December 2004 . While the first group received ceftriaxone 4 gr/day plus dexamethasone , the second group received ceftriaxone 4 gr/day only . Dexamethasone was given 10 - 15 minutes before the first 8 mg dose of antibiotic treatment . It was continued at 16 mg/day for 3 days . RESULTS The study included 144 patients with the diagnosis of acute bacterial meningitis .  Cerebrospinal fluid ( CSF ) was analyzed at the time of admission , after 24 - 48 hours ( Table 1 ) , and at the end of treatment . Accordingly , CSF leukocyte level was found to be 1710+/-2140/mm3 in group 1 receiving dexamethasone treatment compared to 1950+/-2244/mm3 in group 2 ( p=0.001 ) . The consciousness in the group receiving dexamethasone  improved significantly more rapidly than the control group ( p=0.001 ) . While mortality was 9.7 % in the patient group receiving dexamethasone it was 16.7 % in the control group , however , it was not significant ( p=0.093 ) . CONCLUSION The use of dexamethasone in adult patients is still under debate , and the administration of dexamethasone 10 - 15 minutes before antibiotherapy to unconscious patients in a poor state of health , is effective in the clinical improvement of the patient Bacterial meningitis is still an important cause of death and /or persistent nervous system damage in children living in developing countries . The aim of the study was to evaluate the effectiveness of steroids in reducing mortality and neurologic sequelae in children affected by bacterial meningitis within the context of a developing country ( Mozambique ) , where the case-fatality rate of this disease is over 30 per cent . Seventy children with bacterial meningitis were r and omized to receive either  conventional antibiotic therapy or antibiotic therapy plus dexamethasone . On hospital admission there were no statistically significant differences between the two groups with regard to clinical and laboratoristic features . When dexamethasone was used early mortality , within 24 h , was significantly reduced ( 1/34 v. 8/36 , P 
    Output:
    
There was no beneficial effect of corticosteroid therapy in low-income countries .
Corticosteroids significantly reduced hearing loss and neurological sequelae , but did not reduce overall mortality .
Data support the use of corticosteroids in patients with bacterial meningitis in high-income countries .
We found no beneficial effect in low-income countries