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A recent, randomized, controlled study evaluating the effect of adding dexamethasone (10 mg every 6 hours for 4 days) to amoxicillin therapy in adults with pneumococcal meningitis demonstrated significant reductions in mortality and morbidity (see Journal Watch Emergency Medicine Dec 30 2002). With the increasing resistance of Streptococcus pneumoniae to penicillins, cephalosporins and vancomycin have become the antibiotics of choice. However, vancomycin has limited ability to cross the blood-brain barrier, and concern has been raised that steroid use might further reduce its penetration into the cerebrospinal fluid (CSF) by decreasing meningeal inflammation. A prospective observational study from France addressed this concern.
Thirteen adul…