USE OF CORTICOSTEROIDS AND ADJUVANTS IN THE TREATMENT OF BACTERIAL MENINGITIS

Introduction: Bacterial meningitis remains a critical cause of morbidity and mortality worldwide, particularly among neonates, children, and immunocompromised individuals. While antibiotic therapy remains the cornerstone of treatment, inflammatory responses triggered by bacterial lysis contribute significantly to neurological complications. In this context, corticosteroids and other adjunctive therapies have been investigated to modulate immune-mediated damage. Objective: This review aims to explore and synthesize the current evidence on the efficacy and limitations of corticosteroids and other adjuvant agents in bacterial meningitis treatment. Secondary objectives include assessing variations in response based on age, causative organisms, and timing of administration. Methods: A narrative review was conducted using data from PubMed, Scopus, Web of Science, Cochrane Library, and Google Scholar. Studies from the last five years were selected based on relevance to corticosteroid or adjunctive use in the management of acute bacterial meningitis. Clinical trials, meta-analyses, guidelines, and large observational cohorts were prioritized. Results and Discussion: Dexamethasone has shown benefit in reducing hearing loss in cases of pneumococcal meningitis, particularly in high-income countries when administered before or with the first dose of antibiotics. However, its utility in meningococcal or Haemophilus influenzae infections remains inconsistent. New adjuvants under investigation include glycerol, paracetamol, and immunomodulatory agents targeting cytokine cascades, although their clinical application is not yet standardized. Conclusion: Corticosteroids represent a valuable adjunct in the management of bacterial meningitis under specific conditions. Their use should be tailored according to etiology, age group, and regional epidemiological patterns. Continued research into novel adjuvants is essential to improve outcomes and reduce long-term sequelae.