Why is dexamethasone used with ceftriaxone (Rocephin) in adolescents and adults for bacterial infections as a one-time dose?

From the Guidelines

Dexamethasone is given as a one-time dose alongside Rocephin (ceftriaxone) in adolescents and adults with certain bacterial infections, particularly bacterial meningitis, to reduce inflammation and improve outcomes, with the most recent and highest quality evidence supporting its use in pneumococcal meningitis 1. The typical dose is 10mg IV given before or with the first antibiotic dose. This practice is based on evidence that dexamethasone reduces inflammation caused by bacterial cell wall components released when antibiotics kill bacteria, especially in meningitis where inflammation in the confined space of the central nervous system can cause significant damage.

Key Points

• The steroid works by suppressing the inflammatory cascade, potentially preventing complications like hearing loss and neurological damage.
• It's given as a one-time dose or short course because prolonged steroid use could interfere with the immune system's ability to fight infection.
• This adjunctive therapy is most beneficial when given before or simultaneously with the first antibiotic dose to prevent the inflammatory response triggered by bacterial cell lysis.
• The benefit is greatest in pneumococcal meningitis but may help in other severe infections where inflammation contributes significantly to tissue damage, as supported by studies such as 1 and 1.

Administration Timing

• The guideline committee has reached consensus (based on expert opinion) that dexamethasone treatment can still be started up to 4 hours after initiation of antibiotic treatment, as stated in 1.
• However, the most effective timing is when dexamethasone is administered before or with the first dose of antibiotics, as shown in 1 and 1.

From the Research

Use of Dexamethasone with Ceftriaxone

• Dexamethasone is used as an adjunctive therapy with antibiotics, such as ceftriaxone, in the treatment of bacterial meningitis in adults and adolescents 2, 3, 4, 5, 6.
• The primary purpose of using dexamethasone is to reduce the inflammatory response in the subarachnoid space, which is associated with unfavorable outcomes in bacterial meningitis 2, 3, 4.
• Studies have shown that dexamethasone therapy can improve outcomes in adults with bacterial meningitis, including reducing mortality and neurological sequelae 4, 5.
• Dexamethasone is typically administered before or with the first dose of antibiotics, such as ceftriaxone, and continued for 4 days 2, 3, 4.
• The use of dexamethasone as a one-time dose with ceftriaxone may be beneficial in reducing the inflammatory response and improving outcomes in bacterial infections, although the specific evidence for a one-time dose is limited 6.

Benefits and Risks

• The benefits of using dexamethasone with ceftriaxone include reduced mortality, fewer neurological and auditory sequelae, and improved clinical outcomes 4, 5.
• The risks associated with dexamethasone therapy include gastrointestinal bleeding, secondary fever, and psychiatric manifestations, although these risks may be mitigated with appropriate dosing and monitoring 6.
• The evidence suggests that the benefits of dexamethasone therapy outweigh the risks in adults and adolescents with bacterial meningitis, although further studies are needed to confirm these findings 2, 3, 4, 5, 6.