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Addition of dexamethasone is recommended in all adult patients with suspected pneumococcal meningitis (most community-acquired adult patients)
Dose: 0.15 mg/kg IV q6h for 2-4 days
The first dose must be administered 10-20 minutes before or concomitant with the first dose of antibiotics.
Administration of antibiotics should not be delayed to give dexamethasone.
Dexamethasone should not be given to patients who have already started antibiotics.
Continue dexamethasone only if the CSF gram stain shows Gram-positive diplococci or if blood or CSF grows S. pneumoniae.
Consider adding rifampin 300 mg PO BID for suspected S. pneumoniae, pending susceptibilities, if dexamethasone is used. If S. pneumoniae is beta-lactam susceptible, rifampin may be discontinued.
