From the Guidelines
Corticosteroids should be initiated with the first dose of antibiotic treatment in patients with bacterial meningitis, and can still be started up to 4 hours after initiation of antibiotic treatment.
Key Considerations
- The use of dexamethasone is recommended to reduce hearing loss and neurologic sequelae in bacterial meningitis caused by H. influenzae or S. pneumoniae 1.
- Dexamethasone should be stopped if the patient is discovered not to have bacterial meningitis or if the bacterium causing the meningitis is a species other than H. influenzae or S. pneumoniae, although some experts advise that adjunctive treatment should be continued irrespective of the causative bacterium 1.
- The evidence supports the use of corticosteroids in patients with bacterial meningitis beyond the neonatal age in countries with a high level of medical care, but not in low-income countries 1.
- Some studies suggest that dexamethasone can be effective in reducing hearing loss and neurologic sequelae even when started after antibiotic treatment, but the optimal timing is unclear 1.
Important Details
- Dexamethasone should be administered at a dose that is effective in reducing inflammation, but the exact dose is not specified in the guidelines 1.
- The guidelines are based on expert opinion and consensus, as there is limited scientific evidence to support specific recommendations for the timing of corticosteroid therapy 1.
From the Research
Initiation of Corticosteroids in Meningitis Treatment
- The use of corticosteroids as adjunctive therapy in adults with bacterial meningitis has been studied extensively, with evidence suggesting a beneficial effect in reducing mortality and neurological sequelae 2, 3, 4, 5, 6.
- A systematic review of five trials involving 623 patients found that treatment with steroids was associated with a significant reduction in mortality and neurological sequelae in adults with acute bacterial meningitis 2.
- Another study found that adjunctive dexamethasone therapy reduced the rate of unfavorable outcomes from 25 to 15% in adults with bacterial meningitis, with treatment initiated before or with the first dose of antibiotics 5.
- The evidence suggests that corticosteroids should be initiated before or with the first dose of antibiotics in adults with suspected or proven community bacterial meningitis in high-income countries, regardless of bacterial etiology 5, 6.
Key Findings
- A reduction in case fatality rate and neurological sequelae has been observed in adults with bacterial meningitis treated with corticosteroids 2, 4, 5, 6.
- The use of corticosteroids has been found to be beneficial in the treatment of children with acute bacterial meningitis, with a reduction in severe hearing loss and long-term neurological sequelae 6.
- Adverse events were not increased significantly with the use of corticosteroids in the treatment of bacterial meningitis 2, 6.
Recommendations
- Based on the available evidence, adjunctive dexamethasone therapy should be initiated before or with the first dose of antibiotics and continued for four days in all adults with suspected or proven community bacterial meningitis in high-income countries 5.
- Hospitals should have protocols in place to include dexamethasone with the initial antibiotic therapy for adults with bacterial meningitis 5.