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

Dexamethasone Dosing for Bacterial Meningitis

For bacterial meningitis, dexamethasone should be administered at 0.15 mg/kg every 6 hours for 2-4 days in children and 10 mg every 6 hours for 4 days in adults, with the first dose given before or with the first antibiotic dose. 1

Age-Specific Dosing Recommendations

Adults

• Dose: 10 mg every 6 hours 1
• Duration: 4 days 1
• Alternative weight-based dosing: 0.15 mg/kg every 6 hours for 2-4 days 1

Children (≥6 weeks of age)

• Dose: 0.15 mg/kg every 6 hours 1, 2
• Duration: 2-4 days 1, 2

Neonates

• Not recommended - Current evidence does not support the use of dexamethasone in neonatal meningitis 1

Timing of Administration

• Optimal timing: 10-20 minutes before the first antimicrobial dose 1
• Alternative timing: At least concomitant with the first antimicrobial dose 1
• Late administration: Can still be started up to 4 hours after initiation of antibiotic treatment (expert consensus) 1

Indications Based on Causative Organism

Strongly Recommended

• Streptococcus pneumoniae meningitis (adults and children) 1
• Haemophilus influenzae type b meningitis (children) 1

Less Clear Benefit

• Meningococcal meningitis - Benefits less established 1
• Other bacterial pathogens - Some experts recommend continuing regardless of pathogen 1

Clinical Evidence and Outcomes

• In adults with pneumococcal meningitis, dexamethasone significantly reduces:

  • Unfavorable outcomes (26% vs 52%) 1
  • Mortality (14% vs 34%) 1

• In children, dexamethasone reduces:

  • Hearing loss 1
  • Neurologic sequelae 1

Important Considerations and Caveats

• Discontinuation: Consider stopping dexamethasone if the final diagnosis is not bacterial meningitis or if the causative organism is neither H. influenzae nor S. pneumoniae 1

• Prior antibiotic therapy: Adjunctive dexamethasone should not be given to children who have already received antimicrobial therapy, as it is unlikely to improve outcomes in this circumstance 1

• Monitoring: Patients should be monitored for:

  • Hyperglycemia
  • Gastrointestinal bleeding
  • Secondary fever
  • Psychiatric manifestations 3

• Duration: A 2-day regimen appears to be as effective as a 4-day regimen for H. influenzae and meningococcal meningitis in children 4

• Regional considerations: Benefits of dexamethasone are primarily established in high-income countries with high levels of medical care 1

Implementation

Hospitals should establish protocols to ensure dexamethasone is readily available and administered with the initial antibiotic therapy, as prompt use improves prognosis in adults with bacterial meningitis 5.