Treatment of Meningitis in Children

Introduction to Dexamethasone

• Dexamethasone is beneficial in reducing hearing impairment and neurological sequelae in children with H. influenzae type b meningitis, as recommended by the Infectious Diseases Society of America 1
• The American College of Physicians and other medical societies support the use of dexamethasone in pneumococcal meningitis in adults, with significant reductions in unfavorable outcomes (26% vs 52%, p=0.006) and mortality (14% vs 34%, p=0.02) 1

Dosage and Administration

• The recommended dose of dexamethasone for adults is 10 mg every 6 hours for 4 days, and for children, it is 0.15 mg/kg every 6 hours for 2-4 days, as recommended by the American College of Physicians 2, 1
• The following dosing regimens are recommended for specific conditions:

• The optimal timing for dexamethasone administration is 10-20 minutes before the first antimicrobial dose, but it can still be effective if given at least concomitant with the first antimicrobial dose or up to 4 hours after initiation of antibiotic treatment, as recommended by the American College of Physicians 2, 1

Special Considerations

• Dexamethasone is not recommended for neonatal meningitis, and its benefits are less established for meningococcal meningitis, as stated by the American College of Physicians 2
• The benefits of dexamethasone are primarily established in high-income countries with high levels of medical care, as noted by the American College of Physicians 2
• Adjunctive dexamethasone should not be given to children who have already received antimicrobial therapy, as it is unlikely to improve outcomes in this circumstance, as recommended by the Infectious Diseases Society of America 1

Contraindications and Precautions

• Dexamethasone is contraindicated in systemic fungal infections or known hypersensitivity and should be used with caution in patients with diabetes, as it may affect glucose control, as advised by the American Academy of Pediatrics and other medical societies 5, 6, 2, 1
• Patients on dexamethasone should be monitored for hyperglycemia, hypertension, increased risk of infection/sepsis, gastrointestinal perforation, growth parameters, blood pressure, blood glucose levels, and neurodevelopmental parameters, as recommended by the American Academy of Pediatrics and other medical societies 5, 2, 1

Alternative Corticosteroids

• Alternative corticosteroids, such as hydrocortisone, may be considered for pediatric patients due to the reduced risk of adverse effects, particularly neurodevelopmental impairment, with a strength of evidence supporting cautious use, as recommended by the American Academy of Pediatrics and other medical societies 5, 2, 1
• When converting between dexamethasone and prednisone, 4 mg of dexamethasone is approximately equivalent to 20-25 mg of prednisone, due to dexamethasone's higher potency, as noted by the American Academy of Pediatrics and other medical societies 7, 3

Long-term Use and Adverse Effects

• Long-term use of dexamethasone is associated with a higher risk of adverse effects, including osteonecrosis and infection, due to its greater potency, as noted by the American Academy of Pediatrics and other medical societies 7, 3