What adjunctive therapy is recommended in adult bacterial meningitis in several guidelines to reduce neurologic sequelae?

• A. Dexamethasone administered before or with the first antibiotic dose.
• B. Phenytoin to prevent seizures.
• C. Vitamin C infusion.
• D. Mannitol to reduce ICP.

Answer: (A)

Starting a corticosteroid like dexamethasone just before or at the same time as the first antibiotic dose is recommended in adults with acute bacterial meningitis because it blunts the inflammatory response in the meninges. When bacteria are killed by antibiotics, inflammatory mediators flood the CSF and drive neuronal injury, including deafness and other neurologic sequelae. Dexamethasone reduces this inflammatory cascade, lowering the risk of lasting neurologic damage, with the most pronounced benefit in pneumococcal meningitis. Timing is key: give it before or with the first antibiotic dose to maximize the protective effect. A typical approach is dexamethasone 0.15 mg/kg IV every 6 hours for 2–4 days. Other proposed adjuncts like anticonvulsant prophylaxis, Vitamin C, or mannitol aren’t routinely used to reduce neurologic sequelae in this setting.