From the Guidelines
Yes, dexamethasone is recommended in pediatric streptococcal pneumonia meningitis, as it has been shown to reduce hearing loss and neurological complications when administered at 0.15 mg/kg/dose every 6 hours for 2-4 days, with the first dose given before or with the first antibiotic dose 1.
Key Points
- Dexamethasone should be initiated 10–20 min prior to, or at least concomitant with, the first antimicrobial dose 1.
- The benefit of dexamethasone is most established for Streptococcus pneumoniae meningitis, where it significantly reduces hearing loss and neurological complications 1.
- Dexamethasone should be discontinued if the causative organism is later identified as something other than S. pneumoniae or Haemophilus influenzae type b 1.
- The steroid should always be used alongside appropriate antibiotic therapy, typically a third-generation cephalosporin plus vancomycin until susceptibilities are known.
- Contraindications include immunosuppression, septic shock, or suspected cerebral malaria.
Administration and Dosage
- Dexamethasone should be administered at 0.15 mg/kg/dose every 6 hours for 2-4 days 1.
- The first dose should be given before or with the first antibiotic dose 1.
Considerations
- The decision to stop or continue dexamethasone can be made on an individual basis for pathogens other than S. pneumoniae or H. influenzae 1.
- Dexamethasone treatment can still be started up to 4 hours after initiation of antibiotic treatment 1.
From the Research
Use of Dexamethasone in Strep Pneumonia Meningitis
- The use of dexamethasone as an adjunctive therapy in the treatment of strep pneumonia meningitis in pediatric patients is a topic of debate 2, 3.
- Some studies suggest that dexamethasone may be beneficial in reducing sensorineural hearing loss and other long-term sequelae in patients with Haemophilus influenzae meningitis, but its effectiveness in pneumococcal meningitis is less clear 2.
- A survey of pediatric infectious diseases specialists found that only 34% of respondents recommended the use of dexamethasone for suspected Streptococcus pneumoniae meningitis 3.
- Another study found that dexamethasone did not influence the outcome or complications of bacterial meningitis in children or adults, but may improve outcomes when given in the presence of certain poor prognostic parameters 4.
- The optimal treatment of pneumococcal meningitis, including the use of dexamethasone, is still unknown and requires further study 5, 6.
Recommendations for Treatment
- The standard empiric therapy for suspected bacterial meningitis in infants and children older than 1 month of age is the combination of cefotaxime or ceftriaxone and vancomycin 5.
- Dexamethasone may be considered as an adjunctive anti-inflammatory therapy, but its use is not universally recommended 5, 2, 3.
- The choice of antibiotic therapy and the use of dexamethasone should be individualized based on the specific circumstances of each patient and the results of antimicrobial susceptibility testing 5, 6.