Évaluation de la conformité des prescriptions de corticoïdes dans les infections cérébro-méningées au CHU Ibn Rochd de Casablanca
Abstract
Introduction : Les corticoïdes sont prescrits comme adjuvants dans certaines infections cérébro-méningées pour réduire la réponse inflammatoire. Les recommandations internationales précisent la molécule, la posologie et la durée du traitement selon l’étiologie. L’objectif de cette étude était d’évaluer la conformité des prescriptions de corticoïdes aux recommandations internationales dans le service des maladies infectieuses du CHU IBN Rochd de Casablanca. Matériel et méthodes : Il s’agit d’une étude transversale descriptive monocentrique sur un an (du 1er janvier au 31 décembre 2023). Ont été inclus tous les patients hospitalisés pour une infection cérébrale et/ou méningée ayant reçu une corticothérapie. Les dossiers incomplets ont été exclus. Les variables recueillies comprenaient données sociodémographiques, cliniques et thérapeutiques (molécule utilisée, voie d’administration, schéma posologique, durée, protocole d’arrêt et traitements adjuvants). La conformité de la corticothérapie a été évaluée par rapport aux recommandations IDSA, SPILF et OMS. Les données ont été traitées avec SPSS v.23. Résultats : Trente-neuf patients ont été inclus. L’âge moyen de nos patients était de 39,87±15,85 ans avec une prédominance masculine. Vingt-cinq patients, soit 64,1%, ne présentaient aucun antécédent pathologique. Vingt-cinq patients (64,1%) avaient reçu une corticothérapie parentérale et orale ; 25,64% une corticothérapie parentérale seule et 10,25% une corticothérapie orale seule. Méthylprednisolone est prescrite dans la quasi-totalité des cas (87,17%). Les schémas posologiques étaient hétérogènes et souvent prolongés. Une dégression de la corticothérapie a été effectuée chez 75,86% des patients. Une supplémentation en potassium et calcium a été prescrite chez 76,9% des patients et les IPP dans une proportion de 38,46% des cas. Au regard des recommandations, aucune prescription de corticothérapie ne remplissait l’intégralité des critères de conformité définis. Conclusion : Cette étude met en lumière des écarts considérables entre la prescription des corticoïdes et les recommandations internationales en termes de choix de la molécule, de la posologie, de la durée et du traitement adjuvants. Ces résultats soulignent la nécessité d’une actualisation des protocoles thérapeutiques et d’une formation continue des prescripteurs pour un meilleur usage des corticoïdes à l’hôpital.
Introduction: Corticosteroids are prescribed as adjunctive therapy in certain cerebrospinal fluid infections to reduce the inflammatory response. International guidelines specify the molecule, dosage, and duration of treatment according to the etiology. The objective of this study was to evaluate the conformity of corticosteroid prescriptions to international recommendations in the infectious diseases department of the IBN Rochd University Hospital in Casablanca. Material and methods: This was a single-center, descriptive, cross-sectional study conducted over one year (January 1 to December 31, 2023). All patients hospitalized for cerebral and/or meningeal infection who received corticosteroid therapy were included. Incomplete records were excluded. Data collected included sociodemographic, clinical, and therapeutic information (drug used, route of administration, dosage regimen, duration, discontinuation protocol, and adjuvant treatments). Adherence to corticosteroid therapy was assessed against IDSA, FIDS, and WHO guidelines. Data were analyzed using SPSS v.23. Results: Thirty-nine patients were included. The mean age of our patients was 39.87 ± 15.85 years, with a male predominance. Twenty-five patients (64.1%) had no prior medical history. Twenty-five patients (64.1%) received parenteral and oral corticosteroid therapy; 25.64% received parenteral corticosteroid therapy alone, and 10.25% received oral corticosteroid therapy alone. Methylprednisolone was prescribed in almost all cases (87.17%). Dosage regimens were heterogeneous and often prolonged. Corticosteroid therapy was tapered in 75.86% of patients. Potassium and calcium supplementation were prescribed in 76.9% of patients, and proton pump inhibitors (PPIs) in 38.46% of cases. According to the guidelines, no corticosteroid prescription met all the defined compliance criteria. Conclusion: This study highlighted significant deviation between corticosteroid prescriptions and international recommendations regarding the choice of molecule, dosage, duration, and adjuvant treatment. These findings emphasize the need for updated local protocols and continuous prescriber training to ensure rational corticosteroid use in hospital settings.
Downloads
PlumX Statistics
References
2. Belsey MA, Hoffpauir CW, & Smith MHD (1969). Dexamethasone in the treatment of acute bacterial meningitis: the effect of study design on the interpretation of results. Pediatrics, 44:503-13 (https://doi.org/10.1542/peds.44.4.503).
3. Bhatt, S. M., Lauretano, A., Cabellos, C., Halpin, C., Levine, R. A., Xu, W. Z., Nadol, J. B., Jr, & Tuomanen, E. (1993). Progression of hearing loss in experimental pneumococcal meningitis: correlation with cerebrospinal fluid cytochemistry. The Journal of infectious diseases, 167(3), 675–683. https://doi.org/10.1093/infdis/167.3.675.
4. Bodilsen, J., D'Alessandris, Q. G., Humphreys, H., Iro, M. A., Klein, M., Last, K., Montesinos, I. L., Pagliano, P., Sipahi, O. R., San-Juan, R., Tattevin, P., Thurnher, M., de J Treviño-Rangel, R., Brouwer, M. C., & ESCMID Study Group for Infections of the Brain (ESGIB) (2024). European society of Clinical Microbiology and Infectious Diseases guidelines on diagnosis and treatment of brain abscess in children and adults. Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases, 30(1), 66–89. https://doi.org/10.1016/j.cmi.2023.08.016.
5. Briot K, Bernard Cortet, Christian Roux, Laurence Fardet, Vered Abitbol, Justine Bacchetta, Daniel Buchon, Françoise Debiais, Pascal Guggenbuhl, Michel Laroche, Érik Legrand, Éric Lespessailles, Christian Marcelli, Georges Weryha, & Thierry Thomas, (2014). Actualisation 2014 des recommandations sur la prévention et le traitement de l’ostéoporose cortico-induite, Volume 4392, Issue 5, 10/2014, Pages 355-446, ISSN 1169-8330, http://dx.doi.org/10.1016/j.rhum.2014.07.009
6. Brouwer, M. C., McIntyre, P., Prasad, K., & van de Beek, D. (2015). Corticosteroids for acute bacterial meningitis. The Cochrane database of systematic reviews, 2015(9), CD004405. https://doi.org/10.1002/14651858.CD004405.pub5
7. Buttgereit, F., Brand, M. D., & Burmester, G. R. (1999). Equivalent doses and relative drug potencies for non-genomic glucocorticoid effects: a novel glucocorticoid hierarchy. Biochemical pharmacology, 58(2), 363–368. https://doi.org/10.1016/s0006-2952(99)00090-8
8. Charlier, C., Perrodeau, É., Leclercq, A., Cazenave, B., Pilmis, B., Henry, B., Lopes, A., Maury, M. M., Moura, A., Goffinet, F., Dieye, H. B., Thouvenot, P., Ungeheuer, M. N., Tourdjman, M., Goulet, V., de Valk, H., Lortholary, O., Ravaud, P., Lecuit, M., & MONALISA, , (2017). Study group. Clinical features and prognostic factors of listeriosis: the MONALISA national prospective cohort study. The Lancet. Infectious diseases, 17(5), 510–519. https://doi.org/10.1016/S1473-3099(16)30521-7
9. Ciana, G., Parmar, N., Antonio, C., Pivetta, S., Tamburlini, G., & Cuttini, M. (1995). Effectiveness of adjunctive treatment with steroids in reducing short-term mortality in a high-risk population of children with bacterial meningitis. Journal of tropical pediatrics, 41(3), 164–168. https://doi.org/10.1093/tropej/41.3.164
10. Davis, L. E., & Baldwin, N. G. (1999). Brain Abscess. Current treatment options in neurology, 1(2), 157–166. https://doi.org/10.1007/s11940-999-0015-7
11. DEFUENTES G., DUTASTA F., FICKO C. (2009) « DOSSIER - Corticothérapie générale ». Revue Du Praticien Medecine Generale. n°830, p. 741-745
12. de Gans, J., van de Beek, D., & European Dexamethasone in Adulthood Bacterial Meningitis Study Investigators (2002). Dexamethasone in adults with bacterial meningitis. The New England journal of medicine, 347(20), 1549–1556. https://doi.org/10.1056/NEJMoa021334
13. DeLemos, R. A., & Haggerty, R. J. (1969). Corticosteroids as an adjunct to treatment in bacterial meningitis. A controlled clinical trial. Pediatrics, 44(1), 30–34
14. DUGAUQUIER, C., BATAILLE, Y., WILLEMS, E., FRÈRE, P., DE PRIJCK, B., BEGUIN, Y., BARON, F., (2009). TOXOPLASMOSE CÉRÉBRALE COMPLIQUANT UNE MINI-ALLOGREFFE DE CELLULES SOUCHES HÉMATOPOÏÉTIQUES DU SANG PÉRIPHÉRIQUE, Rev Med Liège; 64 : 7-8 : 366-369
15. Freedberg, D. E., Kim, L. S., & Yang, Y. X. (2017). The Risks and Benefits of Long-term Use of Proton Pump Inhibitors: Expert Review and Best Practice Advice From the American Gastroenterological Association. Gastroenterology, 152(4), 706–715. https://doi.org/10.1053/j.gastro.2017.01.031
16. Gijwani, D., Kumhar, M. R., Singh, V. B., Chadda, V. S., Soni, P. K., Nayak, K. C., & Gupta, B. K. (2002). Dexamethasone therapy for bacterial meningitis in adults: a double blind placebo control study. Neurology India, 50(1), 63–67
17. Girgis, N. I., Farid, Z., Mikhail, I. A., Farrag, I., Sultan, Y., & Kilpatrick, M. E. (1989). Dexamethasone treatment for bacterial meningitis in children and adults. The Pediatric infectious disease journal, 8(12), 848–851. https://doi.org/10.1097/00006454-198912000-00004
18. Gundamraj S & Hasbun R (2020) L'utilisation de stéroïdes adjuvants dans les infections du système nerveux central. Front. Cell. Infect. Microbiol. 10:592017. doi: 10.3389/fcimb.2020.592017
19. Haute Autorité de Santé. Les inhibiteurs de la pompe à protons chez l’adulte; 2009. Available from: https://www.has-sante. fr/jcms/r 1439925/fr/les-inhibiteurs-de-la-pompe-a-protons-chez-l-adulte
20. Hoefsloot, S., Urbanski, G., Lacout, C., Bouvard, B., & Lavigne, C. (2021). Quelles mesures adjuvantes associer à une corticothérapie orale prolongée dans le cadre des maladies inflammatoires ? Synthèse des recommandations françaises disponibles [Which adjuvant measures should be associated with long-term oral corticosteroid therapy in inflammatory diseases? A summary of existing French recommendations]. La Revue de medecine interne, 42(9), 616–624. https://doi.org/10.1016/j.revmed.2021.03.326
21. Kanra, G. Y., Ozen, H., Seçmeer, G., Ceyhan, M., Ecevit, Z., & Belgin, E. (1995). Beneficial effects of dexamethasone in children with pneumococcal meningitis. The Pediatric infectious disease journal, 14(6), 490–494. https://doi.org/10.1097/00006454-199506000-00005
22. Kilpi, T., Peltola, H., Jauhiainen, T., & Kallio, M. J. (1995). Oral glycerol and intravenous dexamethasone in preventing neurologic and audiologic sequelae of childhood bacterial meningitis. The Finnish Study Group. The Pediatric infectious disease journal, 14(4), 270–278. https://doi.org/10.1097/00006454-199504000-00005
23. King, S. M., Law, B., Langley, J. M., Heurter, H., Bremner, D., Wang, E. E., & Gold, R. (1994). Dexamethasone therapy for bacterial meningitis: Better never than late?. The Canadian journal of infectious diseases = Journal canadien des maladies infectieuses, 5(5), 210–215. https://doi.org/10.1155/1994/257198
24. Koopmans, M. M., Brouwer, M. C., Bijlsma, M. W., Bovenkerk, S., Keijzers, W., van der Ende, A., & van de Beek, D. (2013). Listeria monocytogenes sequence type 6 and increased rate of unfavorable outcome in meningitis: epidemiologic cohort study. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 57(2), 247–253. https://doi.org/10.1093/cid/cit250
25. Lebel, M. H., Freij, B. J., Syrogiannopoulos, G. A., Chrane, D. F., Hoyt, M. J., Stewart, S. M., Kennard, B. D., Olsen, K. D., & McCracken, G. H., Jr (1988). Dexamethasone therapy for bacterial meningitis. Results of two double-blind, placebo-controlled trials. The New England journal of medicine, 319(15), 964–971. https://doi.org/10.1056/NEJM198810133191502
26. Lebel, M. H., Hoyt, M. J., Waagner, D. C., Rollins, N. K., Finitzo, T., & McCracken, G. H., Jr (1989). Magnetic resonance imaging and dexamethasone therapy for bacterial meningitis. American journal of diseases of children (1960), 143(3), 301–306. https://doi.org/10.1001/archpedi.1989.02150150055017
27. Lucht, F. (1996). Les méningites purulentes communautaires. Conférence de consensus. Med Mal Infect;26:944–51
28. Lutsar, I., Friedland, I. R., Jafri, H. S., Wubbel, L., Ahmed, A., Trujillo, M., McCoig, C. C., & McCracken, G. H., Jr (2003). Factors influencing the anti-inflammatory effect of dexamethasone therapy in experimental pneumococcal meningitis. The Journal of antimicrobial chemotherapy, 52(4), 651–655. https://doi.org/10.1093/jac/dkg417
29. Martinez-Almoyna, L., De Broucker, T., Mailles, A., Stahl, J. P., & Scientific Committee of the French Guidelines on the Management of Infectious Encephalitis in Adults (2019). Management of infectious encephalitis in adults: Highlights from the French guidelines (short version). Revue neurologique, 175(7-8), 436–441. https://doi.org/10.1016/j.neurol.2019.07.009
30. Meyding-Lamadé, U., Jacobi, C., Martinez-Torres, F., Lenhard, T., Kress, B., Kieser, M., Klose, C., Einhäupl, K., Bösel, J., Mackert, M. B., Homberg, V., Koennecke, C., Weißheit, G., Claus, D., Kieseier, B., Bardutzky, J., Neumann-Haefelin, T., Lorenz, M. W., Steinmetz, H., Gerloff, C., … Craemer, E. (2019). The German trial on Aciclovir and Corticosteroids in Herpes-simplex-virus-Encephalitis (GACHE): a multicenter, randomized, double-blind, placebo-controlled trial. Neurological research and practice, 1, 26. https://doi.org/10.1186/s42466-019-0031-3
31. Molyneux, E. M., Walsh, A. L., Forsyth, H., Tembo, M., Mwenechanya, J., Kayira, K., Bwanaisa, L., Njobvu, A., Rogerson, S., & Malenga, G. (2002). Dexamethasone treatment in childhood bacterial meningitis in Malawi: a randomised controlled trial. Lancet (London, England), 360(9328), 211–218. https://doi.org/10.1016/s0140-6736(02)09458-8
32. Mustafa, M. M., Ramilo, O., Mertsola, J., Risser, R. C., Beutler, B., Hansen, E. J., & McCracken, G. H., Jr (1989). Modulation of inflammation and cachectin activity in relation to treatment of experimental Hemophilus influenzae type b meningitis. The Journal of infectious diseases, 160(5), 818–825. https://doi.org/10.1093/infdis/160.5.818
33. Odio, C. M., Faingezicht, I., Paris, M., Nassar, M., Baltodano, A., Rogers, J., Sáez-Llorens, X., Olsen, K. D., & McCracken, G. H., Jr (1991). The beneficial effects of early dexamethasone administration in infants and children with bacterial meningitis. The New England journal of medicine, 324(22), 1525–1531. https://doi.org/10.1056/NEJM199105303242201
34. Peltola, H., Roine, I., Fernández, J., Zavala, I., Ayala, S. G., Mata, A. G., Arbo, A., Bologna, R., Miño, G., Goyo, J., López, E., de Andrade, S. D., & Sarna, S. (2007). Adjuvant glycerol and/or dexamethasone to improve the outcomes of childhood bacterial meningitis: a prospective, randomized, double-blind, placebo-controlled trial. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 45(10), 1277–1286. https://doi.org/10.1086/522534
35. Philippart, F., (2006). Place de la corticothérapie dans l'arsenal thérapeutique aux urgences: mise au point, Réanimation,Volume 15, Issues 7–8, Pages 533-539, ISSN 1624-0693, https://doi.org/10.1016/j.reaurg.2006.10.008.(https://www.sciencedirect.com/science/article/pii/S1624069306001496)
36. Porta, S., Danza, A., Arias Saavedra, M., Carlomagno, A., Goizueta, M. C., Vivero, F., & Ruiz-Irastorza, G. (2020). Glucocorticoids in Systemic Lupus Erythematosus. Ten Questions and Some Issues. Journal of clinical medicine, 9(9), 2709. https://doi.org/10.3390/jcm9092709.
37. Reid, I. R., Bristow, S. M., & Bolland, M. J. (2015). Calcium supplements: benefits and risks. Journal of internal medicine, 278(4), 354–368. https://doi.org/10.1111/joim.12394
38. Report of a workshop: Pathophysiology of bacterial memingitis-- implications for new management strategies. (1987). The Pediatric infectious disease journal, 6(12), 1143–1171
39. Sáez-Llorens, X., Jafari, H. S., Severien, C., Parras, F., Olsen, K. D., Hansen, E. J., Singer, I. I., & McCracken, G. H., Jr (1991). Enhanced attenuation of meningeal inflammation and brain edema by concomitant administration of anti-CD18 monoclonal antibodies and dexamethasone in experimental Haemophilus meningitis. The Journal of clinical investigation, 88(6), 2003–2011. https://doi.org/10.1172/JCI115527
40. Sande, M. A., Täuber, M. G., Scheld, W. M., & McCracken, G. H., Jr (1989). Pathophysiology of bacterial meningitis: summary of the workshop. The Pediatric infectious disease journal, 8(12), 929–933. https://doi.org/10.1097/00006454-198912000-00048.
41. Sankar, J., Singhi, P., Bansal, A., Ray, P., & Singhi, S. (2007). Role of dexamethasone and oral glycerol in reducing hearing and neurological sequelae in children with bacterial meningitis. Indian pediatrics, 44(9), 649–656
42. Schaad, U. B., Lips, U., Gnehm, H. E., Blumberg, A., Heinzer, I., & Wedgwood, J. (1993). Dexamethasone therapy for bacterial meningitis in children. Swiss Meningitis Study Group. Lancet (London, England), 342(8869), 457–461. https://doi.org/10.1016/0140-6736(93)91592-a
43. Stahl, J. P., Azouvi, P., Bruneel, F., De Broucker, T., Duval, X., Fantin, B., Girard, N., Herrmann, J. L., Honnorat, J., Lecuit, M., Mailles, A., Martinez-Almoyna, L., Morand, P., Piroth, L., Tattevin, P., & reviewing group (2017). Guidelines on the management of infectious encephalitis in adults. Medecine et maladies infectieuses, 47(3), 179–194. https://doi.org/10.1016/j.medmal.2017.01.005
44. Strehl, C., & Buttgereit, F. (2014). Unraveling the functions of the membrane-bound glucocorticoid receptors: first clues on origin and functional activity. Annals of the New York Academy of Sciences, 1318, 1–6. https://doi.org/10.1111/nyas.12364
45. Täuber, M. G., Brooks-Fournier, R. A., & Sande, M. A. (1986). Experimental models of CNS infections. Contributions to concepts of disease and treatment. Neurologic clinics, 4(1), 249–264
46. Thomas, R., Le Tulzo, Y., Bouget, J., Camus, C., Michelet, C., Le Corre, P., & Bellissant, E. (1999). Trial of dexamethasone treatment for severe bacterial meningitis in adults. Adult Meningitis Steroid Group. Intensive care medicine, 25(5), 475–480. https://doi.org/10.1007/s001340050883
47. Tunkel, A. R., Hartman, B. J., Kaplan, S. L., Kaufman, B. A., Roos, K. L., Scheld, W. M., & Whitley, R. J. (2004). Practice guidelines for the management of bacterial meningitis. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 39(9), 1267–1284. https://doi.org/10.1086/425368
48. van de Beek D. (2009). Corticosteroids for acute adult bacterial meningitis. Medecine et maladies infectieuses, 39(7-8), 531–538. https://doi.org/10.1016/j.medmal.2009.02.033
49. van der Flier, M., Geelen, S. P., Kimpen, J. L., Hoepelman, I. M., & Tuomanen, E. I. (2003). Reprogramming the host response in bacterial meningitis: how best to improve outcome?. Clinical microbiology reviews, 16(3), 415–429. https://doi.org/10.1128/CMR.16.3.415-429.2003
50. van Furth, A. M., Roord, J. J., & van Furth, R. (1996). Roles of proinflammatory and anti-inflammatory cytokines in pathophysiology of bacterial meningitis and effect of adjunctive therapy. Infection and immunity, 64(12), 4883–4890. https://doi.org/10.1128/iai.64.12.4883-4890.1996
51. Wald, E. R., Kaplan, S. L., Mason, E. O., Jr, Sabo, D., Ross, L., Arditi, M., Wiedermann, B. L., Barson, W., Kim, K. S., & Yogov, R. (1995). Dexamethasone therapy for children with bacterial meningitis. Meningitis Study Group. Pediatrics, 95(1), 21–28
52. WHO Consolidated guidelines on HIV prevention, testing, treatment, service delivery and monitoring: recommendations for a public health approach, 2021 update edition. Geneva: World Health Organization; 2021 (https://iris.who.int/handle/10665/342899)
53. WHO consolidated guidelines on tuberculosis: module 4: treatment: drug-susceptible tuberculosis treatment. Geneva: World Health Organization; 2022 (https://iris.who.int/ handle/10665/353829)
54. WHO guidelines on meningitis diagnosis, treatment and care. Geneva: World Health Organization; 2025. Licence: CC BY-NC-SA 3.0 IGO.
Copyright (c) 2025 Vigniako Roussaint Dossou-Yovo, Ikram Ghicha, Afaf Banid, Imane Rahmoune, Jean-claude Majambere, Hassan Mwanayile, Inas Ouggane, Houda Filali, Kamal Marhoum El Filali
This work is licensed under a Creative Commons Attribution 4.0 International License.
