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Meningococcal Meningitis – Immediate Treatment — SCE Neurology MCQ

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HardCNS InfectionsMeningococcal Meningitis – Immediate TreatmentSCE Neurology

A 46-year-old was transferred after receiving ceftriaxone for strongly suspected bacterial meningitis 14 hours ago. No dexamethasone was given. CSF later confirms pneumococcus. Which statement best reflects current NICE guidance on starting dexamethasone now?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Discuss the 14-hour delay with an infection specialist before selecting dexamethasone

Explanation lettering: E = shown as A · C = shown as B · A = shown as C · B = shown as E

A ignores the important delay. B is too absolute; there can be an individual decision after late presentation. C is correct: dexamethasone is ideally given before or with antibiotics, antibiotics must not be delayed, and if more than 12 hours have passed NICE advises specialist input on whether delayed corticosteroid remains appropriate. D dangerously interrupts antimicrobial therapy. E is not the recommended routine substitution.

Reference: NICE NG240: bacterial meningitis and meningococcal disease: https://www.nice.org.uk/guidance/ng240/chapter/Recommendations