In Bacterial Meningitis, Can Dexamethasone Help?

What are the indications for the addition of dexamethasone to the medication regimen in a child with bacterial meningitis?

----MD

Adjunctive therapy with dexamethasone should be considered in selected cases of bacterial meningitis in infants and children. Dexamethasone has reduced hearing impairment in children with Haemophilus influenza type b meningitis when given with or before starting antimicrobial therapy.

However, data are insufficient to demonstrate a clear benefit of adjunctive dexamethasone therapy in children with pneumococcal meningitis. Therefore, clear indications for its use are not available in these cases. The use of dexamethasone in these patients may be considered after weighing the potential benefits and possible risks on a case-by-case basis, according to expert opinion.

When used, dexamethasone should be given immediately before or at the time antibiotics are started. Once antimicrobial therapy has begun, dexamethasone is unlikely to improve the outcome of patients with bacterial meningitis.

The safety and efficacy of adjunctive dexamethasone therapy in meningitis caused by other bacteria are not known. Dexamethasone is not recommended as part of the therapeutic regimen for bacterial meningitis in neonates.

----Susana Chavez-Bueno, MD Clinical Assistant Professor Department of Pediatrics Section of Community Pediatrics University of Oklahoma Health Sciences Center Oklahoma City