Which component of the empiric meningitis regimen provides MRSA coverage?

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

Answer: (B)

MRSA coverage in empiric meningitis therapy is provided by vancomycin. Cephalosporins such as those that cover pneumococcus and meningitis-causing Gram-negatives do not reliably kill MRSA, so they don’t protect against that organism. Dexamethasone is a corticosteroid used to reduce inflammatory injury, not an antibiotic, so it doesn’t provide antimicrobial coverage. Vancomycin targets Gram-positive organisms including MRSA and is added when MRSA is a concern (for example, healthcare-associated risk or prior MRSA colonization) to ensure MRSA is covered while treatment also addresses the other typical meningitis pathogens with a broad-spectrum agent.