An 8-year-old child with bacterial meningitis receives dexamethasone as adjunctive therapy. The primary mechanism by which dexamethasone reduces morbidity in bacterial meningitis is:
- A Direct bactericidal activity against S. pneumoniae
- B Reduction of antibiotic resistance
- C Reduction of CSF inflammation and cytokine cascade, decreasing brain edema and sensorineural hearing loss ✓
- D Prevention of seizures by membrane stabilization
Correct answer: C. Reduction of CSF inflammation and cytokine cascade, decreasing brain edema and sensorineural hearing loss
Explanation
Adjunctive dexamethasone works by suppressing the host inflammatory cytokine response (TNF-alpha, IL-1, IL-6) triggered by bacterial lysis during antibiotic therapy. This reduces cerebral edema, vasculitis, and — most importantly — sensorineural hearing loss (the most common sequela of H. influenzae and S. pneumoniae meningitis in children). Meta-analyses show most benefit in H. influenzae type b meningitis (when vaccination is incomplete); benefit in pneumococcal meningitis is more contested. It has no intrinsic bactericidal activity.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.