Is Empirical Initiation of Dexamethasone Harmful in Patients with Viral Meningitis?

Adjunctive dexamethasone initiated before or with the first dose of antibiotic has proven beneficial in patients with community-acquired meningitis caused by pneumococci or Haemophilus B and is recommended in international guidelines. When the causative pathogen is initially unknown, many patients receive dexamethasone until these two bacterial etiologies have been ruled out. But what about viral meningitis?

Danish researchers conducted a nationwide cohort study involving 1025 patients (median age, 33) hospitalized with viral meningitis to assess the outcomes associated with number of dexamethasone doses. Patients without confirmed pathogen etiology received more dexamethasone than those with known etiology (5 vs. 3 doses). In all, 64% of pa…