Adjunctive corticosteroids in the treatment of bacterial meningitis
What is the role of adjunctive corticosteroids in the treatment of bacterial meningitis?
The benefits of intravenous corticosteroids in bacterial meningitis come from the reduction of the inflammatory process that leads to significant morbidity and mortality.
Corticosteroids are thought to help decrease intracranial pressure (ICP) and reduce brain edema and meningeal inflammation.
In children, corticosteroids have been shown to reduce the incidence of sensorineural hearing loss.
Studies in adults showed protection in patients with Streptococcus pneumoniae meningitis.
Treatment showed association with significant reduction in unfavorable outcome and mortality.
The dosing regimen is dexamethasone 4 mg intravenously every 6 hours for 4 days with the first dose given 30 minutes prior to the first dose of antibiotics.
If the CSF cultures indicate the pathogen is not S. pneumoniae , the dexamethasone may be discontinued.