From the Guidelines
The recommended dose of Decadron (dexamethasone) for bacterial meningitis is 10 mg IV every 6 hours, with the first dose given shortly before or simultaneously with the antibiotics, as supported by the UK Joint Specialist Societies guideline 1. This dose is crucial in reducing inflammation in the meninges before bacterial cell lysis from antibiotics releases inflammatory components.
- The medication works by suppressing the inflammatory cascade triggered by bacterial components, thereby decreasing cerebral edema and intracranial pressure.
- Dexamethasone is particularly beneficial in pneumococcal meningitis and has been shown to reduce mortality and neurological sequelae, especially hearing loss 1.
- It's essential to note that dexamethasone should only be used when bacterial meningitis is strongly suspected or confirmed, as it may mask symptoms in other conditions and potentially reduce antibiotic penetration into the cerebrospinal fluid if given for viral meningitis.
- Blood glucose levels should be monitored during treatment as dexamethasone can cause hyperglycemia. The ESCMID guideline also supports the use of dexamethasone in bacterial meningitis, recommending a dose of 10 mg every 6 hours for 4 days in adults 1. However, the most recent and highest quality study, the UK Joint Specialist Societies guideline, recommends starting dexamethasone shortly before or simultaneously with the antibiotics, and continuing it for 4 days if pneumococcal meningitis is confirmed or thought probable 1.
From the Research
Dose of Decadron for Meningitis
The recommended dose of Decadron (dexamethasone) for bacterial meningitis varies depending on the specific study and patient population.
- In a study published in 1994 2, children with bacterial meningitis were treated with dexamethasone 0.15 mg/kg intravenously every 6 hours for 2 or 4 days.
- A study from 1989 3 used a dose of 8 mg to children younger than 12 years and 12 mg to adults every 12 hours for 3 days.
- Another study from 1993 4 used a dose of 0.4 mg/kg every 12 hours for 2 days.
- A more recent study from 2010 5 used a dose of 10 mg IV every 6 hours for 4 days, started before or with the first dose of parenteral antibiotics.
- It is also important to note that the use of dexamethasone does not appear to impede the penetration of vancomycin into the cerebrospinal fluid (CSF) of patients with pneumococcal meningitis, as shown in a study from 2007 6.
Key Considerations
When considering the use of Decadron for meningitis, it is essential to take into account the following:
- The specific type of meningitis (e.g. pneumococcal, Haemophilus influenzae, etc.)
- The age and weight of the patient
- The severity of the disease and the presence of any complications
- The potential interactions with other medications, such as vancomycin
Dosage Regimens
Different dosage regimens have been studied, including: