Sir.—A 1991 study showed that adjunctive dexamethasone therapy significantly reduced the rate of neurologic sequelae experienced by children with bacterial meningitis.1 The most recent (1991) recommendation by the American Academy of Pediatrics Committee on Infectious Diseases2 was that "dexamethasone therapy be considered only when the diagnosis of bacterial meningitis has been proven or is strongly suspected on the basis of the CSF [cerebrospinal fluid] examination, Gram-stained smear, or antigen test results", and that "dexamethasone should not be used for suspected or proven aseptic or non-bacterial meningitis." The protocol includes initiating dexamethasone prior to administering the initial dose of antibiotics so as to diminish the host inflammatory response to rapid lysis of a large inoculum of bacteria.
In most cases, these recommendations place the burden of deciding whether to initiate dexamethasone therapy for suspected bacterial meningitis on the emergency medicine physician, since lumbar puncture is performed and the