Sex‐based differences in the response to dexamethasone in bacterial meningitis: Analysis of the European dexamethasone in adulthood bacterial meningitis study

Inflammatory markers have been found at higher concentrations in women than men with bacterial meningitis. To investigate sex‐based differences in the response to dexamethasone, we performed a post hoc analysis of a double‐blind, randomised multicentre trial of dexamethasone (10 mg, 4 times daily for 4 days) vs placebo in adults with bacterial meningitis. The primary outcome measure was the Glasgow outcome scale score at 8 weeks and interaction tests were used to examine subgroup differences. Between June 1993 and December 2001, 301 patients (56% male) were randomly assigned to a treatment group: 157 received dexamethasone and 144 placebo. Although dexamethasone reduced the risk of unfavourable outcome to a greater extent in women (relative risk [RR] 0.42, 95% confidence interval [CI] 0.21–0.86, P = .02) than men (RR 0.79, 95% CI 0.41–1.51, P = .55), on interaction testing (ratio of RR women:men 0.53, 95% CI 0.20–1.39, P = .19) patient sex was not a significant modifier of the effect of dexamethasone.