I would like to get a sense about current practice in the PEM community
of concurrent administration of Decadron with first dose of empiric
antibiotics in suspected meningitis.
There is a reasonable evidence (Cochrane Review 2007) that Decadron
when administered before or with the first dose of AB for total of 4 days
in children with bacterial meningitis, significantly decreases the
incidence of severe hearing loss (RR 0.35, CI 0.18-0.54).
As viral meningitis is much more common, how does one make a
decision to give Decadron before culture result or other evidence for
possibly bacterial pathogen is avaialble?
Frequently, we give AB immediately following and sometimes even
before the LP, so then, when do you give Decadron?
Would you give Decadron in the following cases?
4 month old with clear tap, but CSF pleocytosis WBC 30, 45%
Neutrophils, 50% Lymphs, 0 RBC, glucose and protein normal, negative
10 year old with turbid tap, CSF with WBC 550 predominant neutrophils,
normal glucose, elevated protein, negative Gram stain
16 year old with grossly purulent tap, results of CSF labs pending.
Thanks for sharing your opinions,
PEM, NYU / Bellevue
For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is: