Why Steroids before Antibiotics in Bacterial Meningitis?

Studies have demonstrated that patients with pneumococcal meningitis had reduced mortality (14 versus 34 percent placebo) and hearing loss (ototoxicity) when dexamethasone was given shortly before (~20mins) or concurrently with first dose antimicrobial therapy.

Dosed: Dexa 10mg IV 20mins prior or same time before first dose q6hrs x4 days.

NOTE: Patients who did not have pneumococcal meningitis (i.e meningococcal meningitis) had significantly lower rates of mortality (4 vs. 9 percent placebo), regardless of dexamethasone therapy. Also, patients are unlikely to benefit from steroids if they are started AFTER initiation of antimicrobial therapy.

REFERENCES

1. de Gans J, van de Beek D, European Dexamethasone in Adulthood Bacterial Meningitis Study Investigators. Dexamethasone in adults with bacterial meningitis. N Engl J Med. 2002;347(20):1549.
2. Brouwer MC, McIntyre P, Prasad K, van de Beek D. Corticosteroids for acute bacterial meningitis. Cochrane Database of Systematic Reviews 2015, Issue 9. Art. No.: CD004405. DOI: 10.1002/14651858.CD004405.pub5
3. Lutsar I, Friedland IR, Jafri HS, Wubbel L, Ahmed A, Trujillo M, McCoig CC, McCracken GH Jr. Factors influencing the anti-inflammatory effect of dexamethasone therapy in experimental pneumococcal meningitis. J Antimicrob Chemother. 2003;52(4):651.