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Dexamethasone to prevent neurologic complications of bacterial meningitis in adults

Daniel J Sexton, MD
Section Editor
Stephen B Calderwood, MD
Deputy Editor
Anna R Thorner, MD


Bacterial meningitis continues to result in substantial morbidity and mortality despite the availability of effective antimicrobial therapy. The risk of dying or of developing complications is related to the age and general health of the patient, the causative pathogen, the severity and duration of illness at the time of presentation, and, occasionally, delays in the initiation of antibiotic therapy. (See "Initial therapy and prognosis of bacterial meningitis in adults".)

Early intravenous administration of glucocorticoids (usually dexamethasone) has been evaluated as adjuvant therapy in an attempt to diminish the rate of hearing loss and other neurologic complications as well as mortality in selected patients with bacterial meningitis. The possible protective role of dexamethasone therapy to prevent neurologic complications in selected adult patients will be reviewed here. The neurologic complications of meningitis in adults and more general issues, such as the clinical manifestations, diagnosis, treatment, and prognosis of bacterial meningitis in adults as well as neurologic complications and the role of dexamethasone in neonates and children with bacterial meningitis, are discussed separately. (See "Neurologic complications of bacterial meningitis in adults" and "Clinical features and diagnosis of acute bacterial meningitis in adults" and "Initial therapy and prognosis of bacterial meningitis in adults" and "Bacterial meningitis in the neonate: Neurologic complications" and "Bacterial meningitis in children: Neurologic complications" and "Bacterial meningitis in children older than one month: Treatment and prognosis" and "Bacterial meningitis in children: Dexamethasone and other measures to prevent neurologic complications".)


Complications due to bacterial meningitis can be divided into systemic and neurologic. Systemic complications such as septic shock, disseminated intravascular coagulation, acute respiratory distress syndrome, and septic or reactive arthritis are usually the consequence of the bacteremia that frequently accompanies meningitis [1].

The neurologic complications of bacterial meningitis include:

Impaired mental status

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Literature review current through: Nov 2017. | This topic last updated: Mar 03, 2017.
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