Section 15 · Monograph
Dexamethasone (meningitis)
Reviewed Nov 2026FDA label
DecadronCorticosteroid
- Forms
- IV: 4, 10mg/mL
- Dose
- 0.15mg/kg IV q6h for 2-4 days; first dose before or with the first antibiotic dose
- MOA
- ↓Inflammatory response to bacterial lysis
Indications
- Adjunctive therapy in bacterial meningitis (strongest evidence in adult pneumococcal meningitis)FDA-labeled
Mechanism of Action
- Dampens the inflammatory cytokine surge triggered by bacterial lysis, reducing mortality and hearing loss in pneumococcal meningitis
Full Dosing
Adult / usual
- 0.15mg/kg IV every 6 hours for 2-4 days
- Give 10-20 minutes before or with the first antibiotic dose
- Discontinue if pneumococcal infection is excluded
Contraindications
- Systemic fungal infection
- Hypersensitivity
Drug Interactions
- May reduce CSF penetration of vancomycin — consider combination therapy
- Phenytoin and carbamazepine induce dexamethasone metabolism
Adverse Effects
- Hyperglycemia
- GI bleeding
- Insomnia, agitation
- May mask signs of secondary infection
Monitoring Parameters
- Blood glucose
- GI bleeding signs
- Neurologic status and hearing
Pregnancy & Lactation
- Short course; weigh benefit and risk
- Short courses generally compatible with breastfeeding