High Dose Dexamethasone in Complicated Typhoid Fever: What is the Evidence?

Excerpt

To the Editor: The standard recommendation of giving a high dose of dexamethasone in severe typhoid fever, especially when complicated by neurological findings, lacks any systematic review or meta-analysis. The minimal randomised evidence from two trials [1, 2] which was later disputed by another trial [3] in a tropical disease with a high incidence and a high rate of complications, is debatable. These trials excluded the very high-risk patients who died within 6 h, even though the trial specifically aimed to study high-risk patients. In fact, 68 patients had been randomized in the trial, but only 38 were analysed. For 2 of the 68 cases, it is not even stated which arm they were randomized to. For the other 66 patients, the death difference was not statistically significant (10 ⁄ 33 vs. 18 ⁄ 33, P = 0.057). These data are over 25 y old, and this regimen has not been redemonstrated to be effective in any recent or updated trials. …