corticosteroid therapy in bacterial meningitis

Last reviewed 01/2018

Bacterial meningitis

• do not use corticosteroids in children younger than 3 months with suspected or confirmed bacterial meningitis
• in children older than 3 months (1)
  • 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:
    • frankly purulent CSF
    • CSF white blood cell count greater than 1000/microlitre
    • raised CSF white blood cell count with protein concentration greater than 1 g/litre
    • bacteria on Gram stain
  • if tuberculous meningitis is in the differential diagnosis, then consult expert advice before administering steroids, because steroids may be harmful if given without antituberculous therapy
  • if dexamethasone was not given before or with the first dose of antibiotics, but was indicated, try to administer the first dose within 4 hours of starting antibiotics, but do not start dexamethasone more than 12 hours after starting antibiotics
  • after the first dose of dexamethasone discuss the decision to continue dexamethasone with a senior paediatrician

Meningococcal septicaemia in children and young people (1)

• do not treat with high-dose corticosteroids (defined as dexamethasone 0.6 mg/kg/day or an equivalent dose of other corticosteroids)
• in children and young people with shock that is unresponsive to vasoactive agents, steroid replacement therapy using low-dose corticosteroids (hydrocortisone 0.25 mg/m2 four times daily) should be used only when directed by a paediatric intensivist

Reference:

• 1) NICE (June 2010). Bacterial meningitis and meningococcal septicaemia Management of bacterial meningitis and meningococcal septicaemia in children and young people younger than 16 years in primary and secondary care