Dexamethasone is a synthetic glucocorticoid used in the treatment of inflammatory and immune conditions in children and adults. If another cause of meningitis is confirmed or thought probable, the dexamethasone should be stopped. A 10-mg dose should be administered in-travenously just before or with the first dose of antibiotics in adults who present with suspected bacterial meningitis with- We identified 25 trials, including 4121 participants with acute bacterial meningitis of which seven were performed in adults (over 16 years old), two included both children and adults and the other were performed in children. Ampicillin 50 mg/kg/dose IV q6h or 67 mg/kg/dose IV q8h + Cefotaxime 50 mg/kg/dose IV q6h or q8h 1 - 2 months S. pneumoniae, N. meningitidis, S. agalactiae, H. influenzae Cefotaxime 75 mg/kg/dose IV q6h or + Vancomycin IV 2 months- 18 years N. meningitidis, S. pneumoniae + Preferred: Ceftriaxone 50 mg/kg/dose IV q12h (max: 2 g/dose) + Vancomycin IV Under this protocol, patients with a Glasgow Coma Scale score of less than 15 or who have a focal neurological deficit are treated with intravenous dexamethasone for 4 weeks (0.4 mg/kg per day in week 1, 0.3 mg/kg per day in week 2, 0.2 mg/kg per day in week 3, and 0.1 mg/kg per day in week 4), followed by a taper of oral dexamethasone(4 mg/day . A 10-mg dose should be administered intravenously just before or with the first dose of antibiotics in adults who present with suspected bacterial meningitis without systemic sepsis and should be continued for 4 days in those with pneumococcal disease. Dexamethasone should be considered for infants and children with meningitis when CSF Gram stain testing shows Gram-negative coccobacilli consistent with H influenzae. 1.4.40 Give dexamethasone (0.15 mg/kg to a maximum dose of 10 mg, four times daily for 4 days) for suspected or confirmed bacterial meningitis as soon as possible if lumbar puncture reveals any of the following: Steroid responsive meningitis-arteritis (SRMA) is an immune-mediated inflammatory disease primarily affecting the leptomeninges and associated arteries. We have carried out a prospective, placebo-controlled, double-blind study of dexamethasone in 115 children with acute bacterial meningitis in Switzerland. A regime of 10 mg dexamethasone four times a day for 4 days should be followed. Despite aggressive therapy, many patients will experience long-term neurologic complications. High dose glucocorticoids (dexamethasone) can be used in late term pregnant mares suffering from a life threatening disorder to enhance maturation of the fetus.9 The RESULTS: We evaluated 357 episodes with pneumococcal meningitis in 2006-2009. Dexamethasone is given in usual doses of 0.5 to 10 mg daily, depending on the disease being treated. Measure Purpose: Ensure the rapid diagnosis and treatment of bacterial meningitis. Dexamethasone was started prior to the first dose of antibiotics in the dose of 0.15 mg/kg intravenous 6 hourly for 2 d. Studies comparing different doses were uncommon: in tuberculous meningitis, prednisone at 1 to 2 mg/kg was equivalent to 4 to 10 mg/kg, 113,115 and, in croup, dexamethasone at 0.15 mg/kg was as effective as 0.3 mg/kg and 0.6 mg/kg. Study Rundown: The results of this study show that early adjuvant dexamethasone (10 mg every six hours for four days) reduces morbidity and mortality in adults with acute bacterial meningitis. In these experiments, corticosteroids, and in particular dexamethasone, were able to reduce the inflammatory cascades in the subarachnoid space. In more severe disease conditions doses above 10 mg per day may be required. The patients were randomly assigned to receive either placebo (n = 55) or dexamethasone (n = 60) in addition to optimum antibiotic treatment (100 mg/kg daily ceftriaxone). Bacterial meningitis is a serious infection in children and adults worldwide, with considerable morbidity, mortality, and severe neurological sequelae. Bacterial meningitis. 155 Treatment ranged from a single dose (pharyngitis, peritonsillar abscess, croup, and acute bronchiolitis) to . Dexamethasone should be given prior to or with the first dose of antibiotics in adults suspected of having acute bacterial meningitis. therapy soon after the diagnosis of meningitis was made. Routine administration of adjunctive dexamethasone is no longer recommended for pediatric patients with bacterial meningitis. 3 . Dexamethasone can be stopped if lumbar puncture excludes meningitis or if viral meningitis is suspected. Bhaumik S, Behari M. 1998. Dosage. The first steroid dose was given 15. Original Date of Publication: November 14, 2002. At equipotent anti-inflammatory doses, dexamethasone almost completely lacks the sodium-retaining property of hydrocortisone. 46(3):225-228. Intravenous or oral dexamethasone are well evaluated in randomized study but other oral corticosteroids are not. A lumbar puncture to obtain cerebrosp. Methods: Dexamethasone was started prior to the first dose of antibiotics in the dose of 0.15 mg/kg intravenous 6 hourly for 2 d. Primary outcome measure was mortality. The recommended dose in the SSC guideline, 200 mg hydrocortisone per day, is equivalent to the dose of 6.7 mg of dexamethasone, similar to that used by the RECOVERY study. Dexamethasone treatment in mice with eosinophilic meningitis caused by A. cantonensis infection has been shown to result in the partial inhibition of PA and inflammation (Hou et al., Reference Hou, Tu, Lee, Chen, Chou and Lai 2004; Tu and Lai, Reference Tu and Lai 2006). 7,8 In addition, the administration of dexamethasone was associated with decreased concentrations of prostaglandin E 2 in cerebrospinal fluid and lowered . Low-dose glucocorticoid treatment is the only medication showing a significant reduction in mortality in cases of COVID-19 pneumonia requiring oxygen supplementation or ventilatory support. To evaluate the role of dexamethasone therapy in neonatal meningitis in a randomized placebo controlled trial. In situations of less severity, lower doses will generally suffice while in selected patients higher initial doses may be required. To evaluate the role of dexamethasone therapy in neonatal meningitis in a randomized placebo controlled trial. ), SRMA is the established and most widely used nomenclature which also most . The recommended, evidence-based treatment approach with dexamethasone in patients with bacterial meningitis is: IV 0.15 mg/kg Dexamethasone every 6 hours for 4 days. ; Suggested duration of antibacterial treatment 10 days. 9. de Gans J, van de Beek D; European Dexamethasone in Adulthood 18. A total of 258 patients with CSF culture-proven meningitis were enrolled between 1998 and 2002, before routine dexamethasone therapy was introduced . Able - To standardize this process, 10 mg dexamethasone IV every 6-hours for 4-days should be considered before, with, or as soon as possible after antibiotics in suspected adult bacterial meningitis in the following scenarios: Act Upon - The above dexamethasone dose and caveats should be added to the HMED CSF order set to facilitate recall. Dexamethasone produced significant reductions in intracranial pressure, brain edema, and lactate concentrations in cerebrospinal fluid in experimental H influenzae and S pneumoniae meningitis. Effect of treatment with Bacterial Meningitis Study Investigators. Consider adjunctive treatment with dexamethasone, preferably starting before or with first dose of antibacterial, but no later than 12 hours after starting antibacterial. Animal studies have shown that bacterial lysis occuring with antibiotic treatment leads to inflammation in the subarachnoid space and that treatment with dexamethasone, an anti-inflammatory agent, reduced cerebrospinal fluid inflammation and neurologic . 150 micrograms/kg every 6 hours (max. 3 Keeping in mind that the dose is only given for 4 days, the most common adverse effect is hyperglycemia. Meningitis caused by Haemophilus influenzae. BMJ 2004;329:480. In 22 studies the corticosteroid used was dexamethasone, in three others hydrocortisone or prednisone were used. Adverse effects of dexamethasone in bacterial meningitis The dexamethasone dose studied in the landmark 2002 article is substantialthe 40 mg per day of dexamethasone is equivalent to prednisone 250 mg per day. Current evidence for steroids in bacterial meningitis in children is mixed, but does suggest that steroids may reduce the risk of hearing loss ; Steroids are not recommended in neonates due to possible effects on neurodevelopment; Give the first dose of IV dexamethasone just before or with the first dose of antibiotics. military, search and rescue at altitudes greater than 3500 m): 4 mg orally every 6 hours. Dexamethasone may be added to prevent neurologic sequelae such as hearing loss. Dexamethasone therapy (0.4 mg/kg) was started 10 min before the first dose of ceftriaxone and given every 12 h for 2 days. Can start dexamethasone up until 12 hours after the first dose of antibiotics. Side Effects. For infants and children > 6 weeks old with presumed bacterial meningitis adjunctive therapy with Dexamethasone 0.15 mg/kg 6 hourly for 2 days may be considered after consideration of potential benefits and risks. Dexamethasone is often used before antibiotics in cases of this disease, and improves outcomes.Although . For these drugs, the total daily dose equivalencies to dexamethasone 6 mg (oral or IV) 11 are: Prednisone 40 mg ; Methylprednisolone 32 mg ; Hydrocortisone 160 mg; Half-life, duration of action, and frequency of administration vary among corticosteroids. 2 Approximately 90% of bacterial . Dexamethasone is used to treat conditions such as arthritis, blood/hormone disorders, allergic reactions, skin diseases, eye problems, breathing problems, bowel disorders, cancer, and immune . Dexamethasone was started prior to the first dose of antibiotics in the dose of 0.15 mg/kg intravenous 6 hourly for 2 d. Primary outcome measure was mortality. Objectives: We evaluated the implementation and effectiveness of adjunctive dexamethasone in adults with meningococcal meningitis. is divided by Neurology india. Dexamethasone. Routine use of steroids as adjunctive treatment of bacterial meningitis remains controversial. 3 . Long-acting corticosteroid: Dexamethasone; half-life 36 to 72 hours, administer once daily. -Very High Risk Situations (e.g. View Article Google Scholar 29. Cefotaxime (or ceftriaxone). Usual dose: 2 mg orally every 6 hours OR 4 mg orally every 12 hours. RECOVERY will compare a higher dose of 20 mg of dexamethasone given once daily for five days, followed by 10mg once-daily for a another five days, to the usual low dose treatment given for up to . This consequence was noted by many early researchers soon after chemotherapy was introduced; Fitzpatrick in 19541 reported the outcome of tuberculous meningitis among . METHODS: The participants were eighty neonates with meningitis randomized to receive dexamethasone or saline placebo. as meningitis, severe chemical induced aspiration pneumonia, herpes myelitis and acute lymphangitis. It commonly affects extremes of age (<2 months and >60 years) because of impaired or waning immunity. It is available in forms that can be taken by mouth, through a patch placed on the skin, as a cream, in eye drops, and as an injectable. The dose of 0.7 mg/kg used in the study corresponds to the dose used in earlier studies on adjuvant dexamethasone in experimental pneumococcal meningitis in infant rats . A 2002 randomized control trial on the effects of dexamethasone treatment in adults with meningitis similarly found a reduction in mortality and adverse outcomes, seizure incidence, and cardiorespiratory failure in contrast with the placebo group in pneumococcal meningitis (de Gans and van de Beek, 2002) (see Table 1). Initial dose of 5 million units intravenously, then 2.5 to 3 million units every four hours during the intrapartum period . Adjunctive dexamethasone in bacterial meningitis: a meta . The use of dexamethasone in children with meningitis has been associated with . Although there are a variety of synonyms (polyarteritis, beagle pain syndrome, aseptic suppurative meningitis, etc. Dexamethasone was administered at a dosage of 0.3-0.4 mg/kg (depending on disease severity) per day intravenously for the first week and 0.2-0.3 mg/kg/day intravenously for the second week, followed by either 4 weeks of oral steroid therapy or 2 additional weeks of intravenous therapy and then 4 weeks of oral steroids. Practice implications:Dexamethasone appears to be a safe and beneficial ad-junctive therapy in the treatment of moderate-to-severe acute bacterial meningitis caused by S. pneumoniae. Answer. The mortality rate from bacterial meningitis ranges from 2% in children to 20% in neonates with up to a third of survivors experiencing transient or permanent neurological sequelae. Dexamethasone* 12 mg orally 8 mg orally 8 mg orally twice daily 8 mg orally twice daily 5-HT. Duration of Therapy: Should not exceed 10 days to prevent glucocorticoid toxicity or adrenal suppression. WhatsApp. Treatment of AMS: 4 mg orally/IV/IM every 6 hours. Dexamethasone should be administered 10-20 min before antimicrobial therapy for maximal efficacy. antagonist See selected 5-HT. If the patient was assigned to group A, dexamethasone was discontin-ued after the eighth dose; if the patient was assigned to group B, dexamethasone was given for 4 days. Dexamethasone was started with or before the first dose of antibiotics in 84% of episodes in 2006-2009 and 3% in 1998-2002. ; For H. influenzae type b give rifampicin for 4 days before hospital discharge to those under . The initial dosage of dexamethasone sodium phosphate injection USP may vary from 0.50 mg/day to 9 mg/day depending on the specific disease entity being treated. A total of 301 subjects were randomized to receive intravenous dexamethasone in a dosage of 10 mg every six hours for four days (n = 157) or placebo (n = 144). Their synthetic analogs, including dexamethasone, are primarily used for their anti-inflammatory effects. Consider adjunctive treatment with dexamethasone, preferably starting before or with first dose of antibacterial, but no later than 12 hours after starting antibacterial. Because bacterial meningitis is now known to involve inflammation, trials of corticosteroids, typically dexamethasone, have been conducted in an attempt to blunt inflammatory changes in the subarachnoid space. Addition of dexamethasone is recommended in all adult patients with suspected pneumococcal meningitis (most community-acquired adult patients) Dose: 0.15 mg/kg IV q6h for 2-4 days The first dose must be administered 10-20 minutes before or concomitant with the first dose of antibiotics. In order to minimize side effects, the lowest effective possible dose should be used. Treatment of bacterial meningitiS. Local inflammation of joints If pneumococcal meningitis is confirmed or thought probable, continue dexamethsone for 4 days. ; Suggested duration of antibacterial treatment 10 days. Tuberculous meningitis (TBM) is the most severe form of tuberculosis infection with high mortality. Addition of dexamethasone is recommended in all adult patients with suspected pneumococcal meningitis (most community-acquired adult patients) Dose: 0.15 mg/kg IV q6h for 2-4 days The first dose must be administered 10-20 minutes before or concomitant with the first dose of antibiotics. Pediatric bacterial meningitis is a severe, life-threatening infection of the membranes (meninges) surrounding the brain and spinal cord. Morbidity and mortality rates are high among adult patients with acute bacterial meningitis especially those with pneumococcal meningitis. Give 15-20 minutes prior to the start of antibiotics or at the time of antibiotic administration. , et al. The beneficial effect of dexamethasone was clear in patients with pneumococcal meningitis but a significant benefit was not shown in patients with . We conducted a prospective, randomized, double-blind, multicenter trial of adjuvant treatment with dexamethasone, as compared with placebo, in adults with acute bacterial meningitis. Dexamethasone in adults with bacterial meningitis. ; For H. influenzae type b give rifampicin for 4 days before hospital discharge to those under . 0.32-0.93; P = .027), respectively. de Gans J, van der Beek D; European Dexamethasone in Adulthood Bacterial Meningitis Study Investigators. Rifampicin is a key drug for TBM, but its penetration into the brain is limited, suggesting that a higher dose may be more effective. Methods The participants were eighty neonates with meningitis randomized to receive dexamethasone or saline placebo. 1 Meningitis may have a noninfectious or infectious etiology. and are the predominant causative pathogens in both adults and children. antagonist prescribing information for the recommended dosage none none none *Administer dexamethasone 30 minutes prior to chemotherapy treatment on Day 1 and in the morning on Days 2 through 4. Routine use of dexamethasone is currently not recommended for the treatment of meningitis caused by less common pathogens, such as in neonatal meningitis, bacillary Gram-negative meningitis, and . Tuberculous meningitis, the most devastating complication of tuberculosis, is a leading cause of death among children with tuberculosis. Indication : Preterm pregnancy to accelerate surfactant production; Bronchopulmonary dysplasia (BPD) Adrenal . Meningitis caused by Haemophilus influenzae. For adults (>=18 years): Dexamethasone 10 mg/dose q6h before or concurrently with the initial antibiotic dose and for the first 4 days of therapy (IV initially, okay to switch to enteral after improvement) Current treatment regimens are not based on clinical trials. 1. Dexamethasone (IV) 10mg 6-hourly should be administered for ALL cases of suspected bacterial meningitis: This should be started on admission, either shortly before or simultaneously with antibiotics. The first dose of dexamethasone (0.4 mg/kg every 12 hours IV for 2 days or 0.15 mg/kg every 6 hours for 4 days) should be administered 15-20 minutes before the first dose of antibiotics. per dose 10 mg) for 4 days. Dexamethasone should be discontinued if another microbiological cause of meningitis is confirmed. Methods: We compared 2 Dutch prospective nationwide cohort studies on community-acquired meningococcal meningitis. Dexamethasone therapy for bacterial meningitis in adults: a double blind placebo control study. n engl j med 351;17 www.nejm.org october 21, 2004 dexamethasone for patients with tuberculous meningitis 1743 rifampin, pyrazinamide, ethambutol, and strep- Bacterial meningitis represents a life-threatening inflammation of the meninges. Dexamethasone therapy prevented deafness in patients with H. influenzae type b meningitis only if patients were divided grossly into dexamethasone recipients and nonrecipients and if timing between dexamethasone and ceftriaxone administration was not taken into account (odds ratio, 0.27; 95% CI, 0.09-0.77; P . The first steroid dose should be with or just before the first dose of antibiotics. Background: Neonatal meningitis is a common cause of death and long-term disability among children everywhere, particularly in developing countries. bacterial meningitis. Continue for 2-4 days for pneumococcal meningitis Avoid piperacillin-tazobactam due to poor CNS penetration Use adjusted body weight for obese patients to calculate acyclovir dose: Adjusted body weight = 0.4(Actual Since many children receive a dose of antibiotic before the diagnosis of meningitis is confirmed or before they are transferred to a pediatric hospital, it is important to evaluate the efficacy of dexamethasone if given after the initial dose of antibiotic. Practice Guidelines for Bacterial Meningitis CID 2004:39 (1 November) 1267 IDSA GUIDELINES Practice Guidelines for the Management of Bacterial Meningitis Allan R. Tunkel,1 Barry J. Hartman,2 Sheldon L. Kaplan,3 Bruce A. Kaufman,4 Karen L. Roos,5 W. Michael Scheld,6 and Richard J. Whitley7 1Drexel University College of Medicine, Philadelphia, Pennsylvania; 2Weill Cornell Medical Center . Dexamethasone. A variety of different microorganisms, including both viruses and bacteria can cause meningitis. Bacterial meningitis in adults is a severe disease with high fatality and morbidity rates. Experimental studies have shown that the inflammatory response in the subarachnoid space is associated with an unfavourable outcome. The evidence for use of dexamethasone is strongest for Hib meningitis resulting in reduction risk of hearing loss. Warnings and Interactions.
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