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Emergency Medicine


Answer 5
  1. Administration should occur before or with the first dose of antibiotics. Dexamethasone administered before or with the first dose of antibiotics improves outcomes in patients with acute bacterial meningitis. The recommended dose for adults is 10 mg intravenously every 6 hours for 4 days.9 This treatment plan does not increase the risk of gastrointestinal bleeding. Of note, dexamethasone decreases the blood-brain permeability, which could impede penetration of vancomycin into the subarachnoid space. Treatment failures have been noted in adults receiving vancomycin and dexamethasone. In children, treatment with dexamethasone did not reduce levels of vancomycin in cerebrospinal fluid.

REFERENCES
9. deGans J, van de Beek D; European Dexamethasone in Adulthood Bacterial Meningitis Study Investigators. Dexamethasone in adults with bacterial meningitis. N Eng J Med 2002;347:154956.

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