What is the recommended dose of Decadron (dexamethasone) for meningitis?

Dexamethasone Dosing for Bacterial Meningitis

For suspected or confirmed bacterial meningitis, dexamethasone should be administered at a dose of 10 mg IV every 6 hours for 4 days, with the first dose given shortly before or simultaneously with the first dose of antibiotics. 1

Adult Dosing Protocol

Initial Administration

• Dose: 10 mg IV every 6 hours
• Duration: 4 days (total of 16 doses)
• Timing: First dose should be given:
  • Ideally before the first antibiotic dose
  • Or simultaneously with the first antibiotic dose
  • Can still be started up to 4 hours after initiation of antibiotics 1

Continuation Decision Algorithm

1. If pneumococcal meningitis is confirmed or probable:

   • Continue dexamethasone for the full 4-day course 1

2. If another bacterial cause is identified:

   • For H. influenzae: Continue the full 4-day course
   • For other pathogens: Consider discontinuing dexamethasone 1

3. If non-bacterial etiology is confirmed:

   • Discontinue dexamethasone 1

Pediatric Dosing

• Dose: 0.15 mg/kg IV every 6 hours 1
• Duration: 2-4 days
• Timing: Same as adults - before or with first antibiotic dose

Clinical Evidence and Rationale

Dexamethasone reduces mortality and neurological sequelae by attenuating the inflammatory response in the subarachnoid space. The UK Joint Specialist Societies guideline (2016) provides strong evidence (Grade 1A) for this recommendation 1.

The benefits of dexamethasone are most clearly established for:

• Reduction in hearing loss and neurological sequelae in all bacterial meningitis 1
• Reduction in mortality specifically in pneumococcal meningitis 1

Meta-analyses have shown that dexamethasone is most effective when given before or with the first antibiotic dose, but can still provide benefit when started within 4 hours of antibiotic initiation 1.

Important Considerations

• Critical care involvement: Patients with GCS ≤12, rapidly evolving rash, cardiovascular instability, respiratory compromise, or uncontrolled seizures should be transferred to critical care 1

• Contraindications: Dexamethasone is not recommended for:

  • Neonatal meningitis 1
  • Patients in low-income countries with limited medical resources 1

• Monitoring: Watch for potential adverse effects including secondary fever and gastrointestinal bleeding (more common with longer treatment courses) 2

By following this evidence-based protocol for dexamethasone administration in bacterial meningitis, you can significantly improve patient outcomes by reducing mortality and neurological sequelae, particularly hearing loss.