Corticosteroid therapy in bacterial meningitis

Bacterial meningitis

• for people over 3 months with strongly suspected or confirmed bacterial meningitis, give intravenous dexamethasone
• for babies between 28 days and 3 months old with strongly suspected or confirmed bacterial meningitis, get infection specialist advice on using dexamethasone
• when the causative organism is found:
  • continue dexamethasone if it is pneumococcus or Haemophilus influenzae type b
  • stop dexamethasone for all other organisms
  • if no causative organism is found, get advice from an infection specialist on whether or not to continue dexamethasone
• for people receiving dexamethasone:
  • give the first dose with or before the first dose of antibiotics if possible
  • however, do not delay antibiotics to wait for dexamethasone to be started
  • if dexamethasone is delayed for less than 12 hours after the start of antibiotics, give dexamethasone as soon as possible
  • if dexamethasone is delayed for more than 12 hours after the start of antibiotics, get advice from an infection specialist and decide whether dexamethasone is still likely to provide benefit

Meningococcal disease

• do not routinely give corticosteroids to people with meningococcal disease
• consider low-dose replacement corticosteroids for people with meningococcal septic shock that is not responding to high-dose vasoactive agent

Reference:

1. NICE (March 2024). Meningitis (bacterial) and meningococcal disease: recognition, diagnosis and management