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Dear Group,

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 
Gram stain

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,

Adriana Manikian
PEM, NYU / Bellevue

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