Adjunctive Corticosteroids in Pediatric Meningitis: Current Evidence, Clinical Controversies, and Future Directions
Year: 2026
Type: review
Abstract: Background: Pediatric bacterial meningitis remains an important cause of death and long-term neurological disability despite advances in vaccination, antimicrobial therapy, and supportive care. Because host inflammation contributes substantially to secondary neuronal injury, adjunctive cor-ticosteroids have been investigated as a strategy to reduce inflammation-mediated complications. This narrative review aims to critically evaluate the current evidence on corticosteroid therapy in pediatric meningitis, with particular emphasis on acute bacterial meningitis, major clinical and neurological outcomes, treatment timing, pathogen-specific effects, and the impact of changing post-vaccination epidemiology. Methods: A structured search of PubMed/MEDLINE, Scopus, and Web of Science was conducted for relevant publications available up to June 2026. Randomized controlled trials, observational studies, systematic reviews, meta-analyses, and international guide-lines involving patients aged 0–18 years were considered. Evidence was synthesized narratively, focusing on mortality, hearing loss, neurological sequelae, long-term outcomes, safety, causative pathogen, and timing of corticosteroid administration. Results: Adjunctive dexamethasone does not consistently reduce mortality, hospital stay, intensive care utilization, or healthcare costs. Its most reproducible benefit is a reduction in sensorineural hearing loss, particularly in Haemophilus influenzae type b meningitis. Benefits in pneumococcal meningitis are less consistent, while evidence supporting routine use in meningococcal disease remains limited. Efficacy is greatest when dexa-methasone is administered before or with the first antibiotic dose and appears less pronounced in the post-vaccination era. In tuberculous meningitis, corticosteroids improve survival, whereas rou-tine use is not supported in viral or fungal meningitis. Conclusion: Current evidence supports a se-lective, pathogen- and context-specific approach to corticosteroid therapy in pediatric meningitis. Dexamethasone is best regarded as a neuroprotective adjunct, with hearing preservation repre-senting its most consistent clinical benefit.
Source: Pharmaceuticals
DOI: 10.3390/ph19101563
Language: English
Subfield: Microbiology
Field: Immunology and Microbiology
Domain: Life Sciences
Open Access status: gold
Estimated APC paid: $3,499
OpenAlex ID: W7205017719