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.
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
- 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.
- 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
- 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.