Correct!
5. Prior to first dose of antibiotics
Adjunctive steroids have been shown by numerous randomized controlled trials to be of benefit in the treatment of acute bacterial meningitis. A Cochrane review of 25 RCTs involving >4000 participants found benefit when given either prior to the initiation of antimicrobials or along with the first dose (5). It has been shown to reduce mortality in the setting of Streptococcus pneumoniae meningitis (29.9% vs 36% without steroid administration). Steroids decrease overall rates of severe hearing loss, any hearing loss, and neurologic sequelae in all age groups diagnosed with acute bacterial meningitis (5).
IDSA guidelines recommend dexamethasone 0.15 mg/kg q6h for 2–4 days with the first dose administered 10–20 minutes before antimicrobial therapy in adults with suspected or proven pneumococcal meningitis (6). Dexamethasone should be only be continued if blood or CSF cultures are positive for Streptococcus pneumonia. Dexamethasone is unlikely to help patient if given after antimicrobials (6).
Given the setting of Arizona, this could be coccidioidal meningitis. How does the CSF typically present with this fungal meningitis? (Click on the correct answer to be directed to the seventh and final page)