Effects of acetazolamide in children with meningitis with increased intracranial pressure: a retrospective cohort study

Abstract

OBJECTIVE

To investigate the effects of acetazolamide to reduce cerebrospinal fluid (CSF) pressure in children with meningitis and increased intracranial pressure.

METHODS

We conducted a retrospective cohort study of children (3 to 15 years old) with meningitis and increased intracranial pressure receiving acetazolamide and standard therapy and the children who received standard therapy alone in Khon Kaen Hospital, Thailand between Jan 2009 and December 2015. The primary outcome was the difference of opening CSF pressure change between these two groups.

RESULTS

A total of 85 patients were included in the analysis, 15 were prescribed acetazolamide and 70 were received standard treatment alone. The mean change of opening CSF pressure was similar between the two groups (-13.2±10.9 in acetazolamide group and -7.2±9.7 in the standard treatment group; mean difference, 6.05; 95% confidence interval (CI), -4.83 to 16.93; P=0.26). After adjusting the confounder, adjunct acetazolamide to standard treatment was not related to the opening CSF pressure change (regression coefficients [B], 1.15; 95% CI, -23.20 to 25.50), and the adverse effects included hypokalemia (adjusted odds ratio [AOR], 0.47; 95% CI, 0.06 to 4.06) and metabolic acidosis (AOR, 0.57; 95% CI, 0.07 to 4.76). However, opening CSF pressure at admission was inversely associated with the opening CSF pressure change (B, -0.66; 95% CI, -1.31 to -0.003).

CONCLUSION

In children with meningitis and increased intracranial pressure, adjunct acetazolamide to standard treatment did not have benefit in reduction of CSF pressure.