Indications

Strong clinical suspicion of bacterial meningitis, especially if CSF is turbid

Situations where dexamethasone not advised

Antibiotic therapy already begun (although consider using up to 12 h after antibiotics in pneumococcal meningitis)

Septic shock

Suspected meningococcal disease (petechial/purpuric rash)

Immunosuppressed patient

Regimen

Give dexamethasone 10 mg IV before or with the first dose of antibiotic therapy (Table 68.3)

Continue dexamethasone 10 mg 6-hourly IV for 4 days if CSF shows Gram-positive diplococci, or if blood/CSF cultures are positive for Streptococcus pneumoniae