What is the indication of dexamethasone (corticosteroid) in pediatric meningitis?

From the Guidelines

Dexamethasone is recommended as an adjunctive therapy in pediatric bacterial meningitis, particularly in countries with a high level of medical care, to reduce hearing loss and neurologic sequelae, but not overall mortality, as supported by the most recent guideline evidence 1. The use of dexamethasone in pediatric meningitis is indicated for patients beyond the neonatal age, with the most benefit seen in cases caused by Haemophilus influenzae type b and potentially beneficial for pneumococcal meningitis. Key points to consider include:

• The standard dosing regimen is not explicitly stated in the most recent guideline evidence 1, but previous studies suggest 0.15 mg/kg every 6 hours (0.6 mg/kg/day) for 2-4 days 1.
• Dexamethasone should be started as early as possible, ideally before or simultaneously with antibiotic therapy, to maximize its benefits in reducing inflammation and preventing neurological complications.
• The benefits of dexamethasone are most established for H. influenzae type b meningitis, with evidence suggesting benefit in pneumococcal meningitis as well, particularly in preventing hearing loss 1.
• In areas with high rates of antibiotic pretreatment or in meningitis caused by other pathogens, the benefits of dexamethasone may be less clear, requiring clinical judgment 1.
• Dexamethasone is contraindicated in fungal meningitis and should be used cautiously in immunocompromised patients, although these specifics are not detailed in the most recent guideline evidence 1.

From the Research

Indication of Dexamethasone in Pediatric Meningitis

The use of dexamethasone, a corticosteroid, as an adjunctive therapy in pediatric meningitis has been studied in various clinical trials. The evidence suggests that dexamethasone can be beneficial in certain types of bacterial meningitis in children.

• The studies 2, 3, 4, 5 indicate that dexamethasone can reduce the incidence of severe hearing loss and other neurological deficits in children with Haemophilus influenzae type b (Hib) meningitis.
• The evidence 2, 6, 4 also suggests that dexamethasone may be beneficial in pneumococcal meningitis, particularly if administered early, before or with the first dose of antibiotics.
• However, the use of dexamethasone in meningococcal meningitis is not recommended 5, and its use in gram-negative bacillary meningitis and neonatal meningitis is also not currently recommended 4.
• The optimal duration of dexamethasone therapy is still a matter of debate, but the studies 2, 3 suggest that a 2-day regimen may be sufficient and may reduce the risk of adverse effects.

Key Findings

• Dexamethasone reduces severe hearing loss in Hib meningitis 2, 3.
• Early administration of dexamethasone is crucial for its effectiveness 2, 6, 4.
• The use of dexamethasone in pneumococcal meningitis may be beneficial, but more research is needed 2, 6, 4, 5.
• Dexamethasone is not recommended for meningococcal meningitis 5.

Adverse Effects

• The studies 2, 3 report that dexamethasone is generally well-tolerated, but adverse effects such as secondary fever and gastrointestinal tract bleeding can occur, particularly with longer durations of therapy.