use decadron in strep pneumo suspected meningitis

This patient presents with high fever, altered mental status, and a stiff neck, which, taken together, are highly suggestive of bacterial meningitis. Streptococcus pneumoniae is the most common cause of bacterial meningitis in older adults in developed countries. Initial therapy for S pneumoniae meningitis is a third-generation cephalosporin, but, due to the recent increase in penicillin resistance to Pneumococcus, empiric monotherapy with a penicillin or cephalosporin is no longer recommended. Instead, vancomycin should be added to the regimen until cultures show that there is no penicillin resistance. This patient’s age and steroid therapy put him at risk for infection with Listeria, so he should be empirically treated with ampicillin until cultures are negative. Total duration of antibiotic therapy for culture-proven S pneumoniae meningitis is 10 to 14 days.

Bacterial meningitis has a high mortality and is associated with complications. Neurological complications are common and include altered mental status, increased intracranial pressure, seizures, and hearing loss. The early administration of dexamethasone (0.15 mg/kg every 6 h for 4 days) in patients with suspected bacterial meningitis has been shown to reduce the rate of hearing loss and other neurological complications. If cerebrospinal fluid or blood cultures do not grow S pneumoniae, then dexamethasone should be stopped prior to completing 4 days of therapy.123456

Footnotes

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