Which adjunctive therapy is recommended in acute bacterial meningitis due to Streptococcus pneumoniae to reduce the risk of hearing loss?

Which adjunctive therapy is recommended in acute bacterial meningitis due to Streptococcus pneumoniae to reduce the risk of hearing loss?

• A. Hydrocortisone.
• B. Prednisone.
• C. Dexamethasone.
• D. No adjunctive therapy.

Answer: (C)

Administering a corticosteroid to blunt the inflammatory response in acute pneumococcal meningitis helps protect the inner ear from inflammatory damage that can cause hearing loss. Dexamethasone is preferred because it rapidly reaches the CSF and suppresses the cytokine-mediated inflammation that antibiotics trigger when they lyse the bacteria, reducing cochlear injury. The benefit is greatest when dexamethasone is given just before or with the first dose of antibiotics. Other steroids like hydrocortisone or prednisone have not shown the same consistent protective effect in this setting, and omitting adjunctive therapy misses a proven way to lower the risk of hearing loss. In practice, a typical approach is dexamethasone given around the time antibiotics are started, with dosing adjusted for age and weight.

Administering a corticosteroid to blunt the inflammatory response in acute pneumococcal meningitis helps protect the inner ear from inflammatory damage that can cause hearing loss. Dexamethasone is preferred because it rapidly reaches the CSF and suppresses the cytokine-mediated inflammation that antibiotics trigger when they lyse the bacteria, reducing cochlear injury. The benefit is greatest when dexamethasone is given just before or with the first dose of antibiotics. Other steroids like hydrocortisone or prednisone have not shown the same consistent protective effect in this setting, and omitting adjunctive therapy misses a proven way to lower the risk of hearing loss. In practice, a typical approach is dexamethasone given around the time antibiotics are started, with dosing adjusted for age and weight.