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Dexamethasone Bacterial Meningitis — FRCA Final MCQ

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HardIntensive Care MedicineDexamethasone Bacterial MeningitisFRCA Final

A 50-year-old man on the ICU with pneumococcal meningitis and raised ICP is being managed with IV ceftriaxone and dexamethasone. His ICP rises to 30 mmHg despite medical management. In bacterial meningitis with raised ICP, which treatment is specifically recommended in addition to antibiotics?

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Correct answer: D — Dexamethasone 0.15 mg/kg QDS for 4 days (started before or with the first antibiotic dose)

NICE CG102 and Cochrane evidence support IV dexamethasone 0.15 mg/kg QDS for 4 days in suspected bacterial meningitis, ideally started before or with the first dose of antibiotics. In pneumococcal meningitis specifically, dexamethasone reduces mortality (from 34% to 14% in the de Gans trial) and neurological sequelae. The mechanism: dexamethasone reduces the inflammatory cascade triggered by bacterial lysis (which worsens cerebral oedema and ICP). If the organism is subsequently confirmed as non-pneumococcal (e.g., meningococcal) in adults, dexamethasone can be discontinued.

Reference: NICE – 2015 – CG102 Meningitis; de Gans J et al – 2002 – Dexamethasone in bacterial meningitis