A 9-year-old child with bacterial meningitis (CSF: WBC 1500/mm3, 90% neutrophils, glucose 12 mg/dL, protein 300 mg/dL) is started on IV ceftriaxone. The child has no known drug allergies and no history of contact with a patient on treatment for tuberculosis. According to current guidelines, what is the recommended timing of adjunctive dexamethasone administration?

• A Only if the child has raised intracranial pressure
• B Only if the child is known to have pneumococcal meningitis
• C After CSF culture and sensitivity results are available
• D 10 to 20 minutes before or with the first dose of antibiotics ✓

Explanation

Adjunctive dexamethasone should be given 10 to 20 minutes before or simultaneously with the first dose of antibiotics. If given after antibiotics have already been administered, the benefit is reduced because dexamethasone works by blunting the inflammatory response triggered by bacterial lysis from antibiotics. In the Indian context, dexamethasone 0.15 mg/kg every 6 hours for 4 days is recommended for suspected or proven bacterial meningitis in infants and children over 6 weeks.

Reference: Indian Academy of Pediatrics guidelines / Nelson Textbook of Pediatrics, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.