Meningitis in adults requires empiric antibiotics promptly. Which adjunctive therapy is often given to reduce neurologic complications?

• A. No adjunctive therapy
• B. Antivirals
• C. NSAIDs
• D. Dexamethasone administered with first dose of antibiotics in suspected bacterial meningitis.

Answer: (D)

When the meninges are infected, the body’s inflammatory response can cause swelling and neuronal injury. Giving a corticosteroid early helps blunt that reaction, lowering the risk of lasting neurologic problems. Dexamethasone started with the first dose of antibiotics soaks up the inflammatory mediators right as the bacteria are being killed, which reduces damage in the brain and inner ear. In adults, this approach especially benefits those with pneumococcal meningitis and has been shown to improve outcomes when timing is right, without delaying antibiotics.

Other options don’t provide this specific protective effect. Antivirals are for viral etiologies, not typical bacterial meningitis. NSAIDs don’t reduce the inflammatory damage in the meninges in the way steroids do. Saying no adjunctive therapy would ignore the established benefit of dexamethasone in suspected bacterial meningitis.