A 6-year-old develops acute bacterial meningitis. CSF shows glucose 18 mg/dL (blood glucose 95 mg/dL), protein 280 mg/dL, WBC 800/µL (90% PMN), and Gram stain shows gram-negative diplococcus. Ceftriaxone is started. Dexamethasone is given 15 minutes before the first antibiotic dose. For which organism is dexamethasone adjunctive therapy MOST evidence-based in pediatric bacterial meningitis?
- A Neisseria meningitidis
- B Streptococcus pneumoniae
- C Haemophilus influenzae type b ✓
- D Listeria monocytogenes
Explanation
Dexamethasone adjunctive therapy in pediatric bacterial meningitis has the strongest evidence for Haemophilus influenzae type b (Hib) meningitis, where it reduces the incidence of post-meningitic sensorineural hearing loss significantly. Evidence for pneumococcal meningitis is mixed, with some trials showing reduction in neurological sequelae. For meningococcal meningitis, the benefit is less clear. Dexamethasone should NOT be given (or should be discontinued) if Listeria is suspected/confirmed as it may worsen outcomes. The Gram-negative diplococcus in this case suggests Neisseria meningitidis, but the question asks for strongest evidence-base.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.