Which drug in meningitis regimen provides MRSA coverage?

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

Answer: (B)

Vancomycin provides MRSA coverage in meningitis regimens. MRSA is not reliably targeted by beta-lactams, so an agent that inhibits cell wall synthesis by binding the D-Ala-D-Ala terminus is added to empiric therapy to cover resistant Staphylococcus aureus. Vancomycin penetrates the CSF better when the meninges are inflamed, making it effective for meningitis alongside a cephalosporin that covers common pathogens like S. pneumoniae and Neisseria meningitidis. Dexamethasone is an anti-inflammatory adjunct, not an antimicrobial. If vancomycin isn’t suitable, alternatives like linezolid can be considered, but vancomycin remains the standard MRSA-covering drug in meningitis regimens.