Controversies in neurology, Vienna, 2012: Steroids in bacterial meningitis: no

In acute bacterial meningitis long-term morbidity and mortality are still high, in particular, in low and middle income countries where meningococci are the most frequent causative agents of this disease. If at all, dexamethasone has been shown to be helpful in pneumococcal meningitis, i.e., in elderly Europeans and not in adolescent African, Asian or South American patients. Since deranged glucose, in particular, glucose variability and deranged coagulation homeostasis are known to be deleterious in patients with bacterial meningitis, dexamethasone—being capable to cause both—might add to morbidity and mortality. After more than 20 prospective trials evidence still lacks that dexamethasone improves outcome in the majority of patients. Dexamethasone only exerts a positive effect, if given prior to the first dose of antibiotic; therefore, the introduction of empiric antimicrobial chemotherapy into the emergency (= pre-hospital) management of patients with suspected bacterial meningitis, the discussion on dexamethasone in acute bacterial meningitis is rendered almost futile.