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Patients with suspected meningitis and which one of the following characteristics are most likely to benefit from adjunctive dexamethasone?
A. Severe disease (as indicated by a score of less than 8 on the Glasgow Coma Scale).
B. Pneumococcal meningitis.
C. Coexisting septic shock.
D. Age less than 18 years.
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D
Also in Tubercular meningitis,HiB
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abrahem could u explain why B
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The correct answer is B. Choices A, C, and D are incorrect. A recent clinical trial demonstrated that the benefit of adjunctive dexamethasone was greatest in patients with intermediate disease severity, as defined by a score on the Glasgow Coma Scale on admission of 8 to 11 (scores can range from 3 to 15, with 15 indicating a normal level of consciousness), and in those with pneumococcal meningitis, in whom unfavorable outcomes declined from 52 percent to 26 percent (number needed to treat, four). In patients with pneumococcal meningitis, mortality was reduced from 34 percent to 14 percent. There are no controlled studies of the effects of corticosteroid therapy in a substantial number of children or in a substantial number of patients with both meningitis and septic shock, and therefore corticosteroid therapy cannot be unequivocally recommended for such patients.
