Steroid therapy combined with antibiotics for bacterial meningitis in
pediatric patients remains controversial. Steroids, and primarily dexa
methasone, a very potent anti-inflammatory agent, regulate the Liberat
ion of various cytokines and inflammatory mediators such as prostaglan
dins, released during bacterial meningitis which may lead to long term
complications, Several clinical trials studying infants and children
with bacterial meningitis due to Haemophilus influenzae have assessed
the beneficial effects of administering dexamethasone at the onset of
antibiotherapy and have demonstrated that dexamethasone reduced the ri
sk of acquired deafness (bilateral, moderate, or more severe hearing l
oss) and the incidence of neurological sequela. Limited information is
available for other bacterial meningitis, However, meningococcal meni
ngitis will become more frequent than Haemophilus meningitis due to th
e efficacy of the haemophilus vaccine. Some S. pneumoniae are now resi
stant to third generation cephalosporins and using dexamethasone in th
at case may be hazardous. Furthermore, no evidence is available as to
the effective role of dexamethasone in neonatal bacterial meningitis,
although it is quite often administered in that age group.