A standard empiric regimen for suspected meningitis in adults commonly includes which corticosteroid?

• A. Dexamethasone
• B. Acyclovir
• C. Ceftriaxone
• D. Vancomycin

Answer: (A)

Steroids are used in suspected bacterial meningitis to blunt the inflammatory response that occurs after bacteria are killed by antibiotics. This inflammation can damage the meninges and nearby structures, leading to neurologic complications and, notably, hearing loss. Dexamethasone is chosen because it effectively reduces the release of inflammatory mediators in the CSF when given just before or with the first antibiotic dose. This timing maximizes benefit and has been shown to improve outcomes, especially in pneumococcal meningitis. Because of this, a standard empiric regimen for adults typically includes dexamethasone alongside the antibiotics (such as a third-generation cephalosporin with vancomycin). The corticosteroid should be administered before or at the exact moment antibiotics are given; delaying it reduces its protective effect. The other options listed are antibiotics or antivirals, not corticosteroids, so they do not fulfill the adjunctive steroid role.