Which statement about dexamethasone in empiric meningitis therapy is correct?

• A. It is never used
• B. It treats the infection directly
• C. It reduces fever only
• D. It reduces inflammatory complications

Answer: (D)

Dexamethasone is used as an adjunct in suspected bacterial meningitis to blunt the inflammatory reaction in the meninges. The damage in meningitis isn’t caused solely by the bacteria but largely by the body's inflammatory response to the infection and to treatment. By dampening this response, dexamethasone lowers the risk of inflammatory complications that can cause lasting neurologic damage, such as hearing loss, and other sequelae. The benefit is greatest when dexamethasone is given before or with the first dose of antibiotics, and it’s most clearly beneficial for Hib meningitis in children and pneumococcal meningitis in adults. It does not directly kill the bacteria, so it’s not a standalone antimicrobial, and while fever may be reduced, the main purpose is reducing inflammatory injury.