A 35-year-old male presents with severe headache, photophobia, fever (39.2°C), and neck stiffness. Kernig's and Brudzinski's signs are positive. Suspecting acute bacterial meningitis, which adjuvant medication should be administered before or concurrently with the first dose of empiric intravenous antibiotics (Ceftriaxone + Vancomycin)?

Answer and explanation

Correct answer: B. Intravenous Dexamethasone

  1. Step 1: In suspected community-acquired acute bacterial meningitis (predominantly Streptococcus pneumoniae), adjuvant intravenous Dexamethasone (10 mg IV every 6 hours for 4 days) should be administered before or with the first dose of antibiotics.
  2. Step 2: Dexamethasone attenuates the intense subarachnoid inflammatory cascade triggered by antibiotic-induced bacterial lysis, significantly reducing neurological hearing loss, cerebral edema, and mortality.
  3. Step 3: It should be discontinued if the pathogen is determined to be non-pneumococcal.
Answer
Intravenous Dexamethasone.
Why not the others: 'Mannitol' is an osmotic diuretic indicated for signs of herniation, not routine adjuvant therapy; 'Acetaminophen' treats fever without reducing neurological sequelae; 'Acyclovir' covers HSV encephalitis (presenting with temporal focal deficits), not typical purulent bacterial meningitis.

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