Decadron in meningitis

Q: Early intravenous (IV) administration of dexamethasone in bacterial meningitis particularly decreases the risk of? (select one)

A) hearing loss

B) vision loss

Answer: A

Administration of IV glucocorticoids has now become the standard of care in the early management of community-acquired bacterial meningitis. Dexamethasone is considered as the drug of choice. The dose is 10 mg administered 15 to 20 minutes prior or with the first dose of antibiotic every 6 hours for 96 hours. It has been found particularly useful in decreasing hearing loss in bacterial meningitis, which can be permanent. It also decreases other neurologic complications and overall mortality by decreasing cerebrospinal fluid (CSF) concentrations of cytokines, CSF inflammation, and cerebral edema.

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References:

1. Bhatt SM, Lauretano A, Cabellos C, et al. Progression of hearing loss in experimental pneumococcal meningitis: correlation with cerebrospinal fluid cytochemistry. J Infect Dis 1993; 167:675.

2. de Gans J, van de Beek D; European Dexamethasone in Adulthood Bacterial Meningitis Study Investigators. Dexamethasone in adults with bacterial meningitis. N Engl J Med. 2002 Nov 14;347(20):1549-56. doi: 10.1056/NEJMoa021334. PMID: 12432041.

3. Gijwani D, Kumhar MR, Singh VB, Chadda VS, Soni PK, Nayak KC, Gupta BK. Dexamethasone therapy for bacterial meningitis in adults: a double blind placebo control study. Neurol India. 2002 Mar;50(1):63-7. PMID: 11960154.