A 70-year-old man with bacterial meningitis (CSF: protein 280 mg/dL, glucose 22 mg/dL, WBC 1800/µL — 92% PMN, gram-positive diplococci) is started on ceftriaxone. Adjunctive dexamethasone should be given to reduce the risk of which primary complication?

• A Brain herniation
• B Renal failure from antibiotic toxicity
• C Sensorineural hearing loss ✓
• D Waterhouse-Friderichsen syndrome

Explanation

Adjunctive dexamethasone (0.15 mg/kg IV q6h for 4 days, given before or with first antibiotic dose) is indicated in adult bacterial meningitis, primarily to reduce sensorineural hearing loss and neurological sequelae, particularly in S. pneumoniae meningitis. The European Dexamethasone Study showed significant reduction in hearing loss and mortality in pneumococcal meningitis. Its benefit in Neisseria meningitidis is less clear. Steroids do not primarily prevent herniation, antibiotic toxicity, or Waterhouse-Friderichsen syndrome.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.