Hospital management of Bacterial Meningitis in adults

Adding Dexamethasone:

• Dexamethasone has been shown to improve the neurological outcome of bacterial meningitis but should be avoided in viral meningitis.  

• The evidence indicates that early use of dexamethasone reduces mortality in adults with pneumococcal meningitis.

• The neurological and audiological sequelae that can complicate Haemophilus influenzae-meningitis are also improved. In the case of meningococcal meningitis a favourable trend has been noted but the use of steroids remains unproven. 

• There is no role for steroids routinely in viral encephalitis.

Recommendation 

Therefore Dexamethasone should be added if there the patient has a  high likelihood of bacterial meningitis, based on clinical features or CSF examination.  

IV Dexamethasone (base) 8mg qds for 4 days

N.B. (8mg Dexamethasone base is approximately equivalent to 10mg Dexamethasone sodium phosphate).

• This should be administered BEFORE (or with) the first dose of antibiotic.

• The most commonly reported adverse effect of steroids in treating meningitis is gastrointestinal bleeding (1% of those treated).

Contra-indications

• Viral meningitis

• Patients where the diagnosis of meningitis is uncertain or in doubt

• Patients already treated with IV antibiotics (including benzylpenicllin from GP)

• Patients with septic shock complicating meningitis

• Immunosuppressed patients

• Meningitis following surgery

Caution; the antibiotic doses recommended on this website are intended for adult patients with normal renal and liver function unless otherwise stated. Dosing advice for patients with renal impairment is available here.

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