Adjunct therapy that reduces inflammatory damage in suspected bacterial meningitis when given early is which drug?

• A. Dexamethasone
• B. Acyclovir
• C. Mannitol
• D. Phenytoin

Answer: (A)

Giving an anti-inflammatory corticosteroid early in suspected bacterial meningitis reduces the inflammatory damage caused by bacterial lysis and the ensuing cytokine storm in the meninges. Dexamethasone penetrates the meninges and dampens this inflammatory response, which lowers the risk of neurologic complications such as hearing loss and other sequelae. The benefit is greatest when started just before or with the first dose of antibiotics, especially in pneumococcal meningitis in adults and Hib meningitis in children. The other options don’t address this inflammatory cascade: acyclovir targets viral infections, mannitol lowers intracranial pressure without reducing meningeal inflammation, and phenytoin is used to prevent seizures.