What is the role of dexamethasone in the treatment of meningitis?

From the Guidelines

Dexamethasone is strongly recommended as an adjunctive therapy in bacterial meningitis, particularly in adults and children with pneumococcal meningitis, to reduce the risk of severe hearing loss and other neurological sequelae. The standard regimen is dexamethasone 0.15 mg/kg every 6 hours for 2-4 days, with the first dose given before or with the first dose of antibiotics 1. This timing is crucial as dexamethasone works by reducing inflammation caused by bacterial cell wall lysis during antibiotic treatment. The anti-inflammatory effect of dexamethasone helps decrease intracranial pressure and limits neurological damage by suppressing the release of inflammatory cytokines.

Key points to consider when using dexamethasone in meningitis include:

• Starting dexamethasone with the first dose of antibiotics is recommended, but it can still be beneficial when started up to 4 hours after initiation of antibiotic treatment 1.
• Dexamethasone is most effective in reducing hearing loss and neurologic sequelae in pneumococcal meningitis, and its use is also beneficial in H. influenzae meningitis 1.
• The use of dexamethasone in meningococcal meningitis is not well established, and its effectiveness in reducing hearing loss or death is unclear 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.

Overall, the use of dexamethasone as an adjunctive therapy in bacterial meningitis has been shown to improve outcomes, particularly in pneumococcal meningitis, and its use is recommended in accordance with current guidelines 1.

From the Research

Role of Dexamethasone in Meningitis Treatment

• Dexamethasone is used as an adjunctive therapy in the treatment of bacterial meningitis to reduce inflammation in the subarachnoid space 2.
• The use of dexamethasone has been shown to improve outcomes in infants and children with bacterial meningitis, with a reduced risk of neurological or audiological sequelae 3.
• In adults, adjunctive dexamethasone therapy has been shown to reduce the rate of unfavourable outcomes, including mortality and neurological sequelae 2, 4.

Dosage and Administration

• The recommended dosage of dexamethasone varies, but it is typically given at a dose of 0.15-0.4 mg/kg every 6-12 hours for 2-4 days 5, 3, 6.
• Dexamethasone should be initiated before or with the first dose of antibacterials, and continued for 4 days in adults with suspected or proven bacterial meningitis 2.

Benefits and Risks

• The benefits of dexamethasone therapy include reduced inflammation, improved clinical response, and reduced risk of neurological or audiological sequelae 5, 3, 2.
• The risks of dexamethasone therapy include secondary fever, gastrointestinal tract bleeding, and psychiatric manifestations, although these are relatively rare 6.
• Dexamethasone is not currently recommended for the treatment of gram-negative bacillary meningitis and neonatal meningitis 4.

Clinical Evidence

• Several studies have demonstrated the efficacy of dexamethasone in reducing morbidity and mortality in patients with bacterial meningitis 5, 3, 2, 4, 6.
• A quantitative review of these studies has shown a consistent beneficial effect of dexamethasone on mortality and a borderline statistical beneficial effect on neurological sequelae 2.