Bottom line: Cochrane systematic review found support for use of corticosteroids in meningitis patients in high-income countries. Administering corticosteroids with the first dose of antibiotics as opposed to after the first dose led to similar results with regard to mortality and slightly more favorable results for severe hearing loss and short-term neurological signs.
Source and complete quotes:
Brouwer, Matthijs C, et al. “Corticosteroids for acute bacterial meningitis.” Cochrane Database of Systematic Reviews 6(2013):CD004405.
“Corticosteroids significantly reduced hearing loss and neurological sequelae, but did not reduce overall mortality. Data support the use of corticosteroids in patients with bacterial meningitis in high-income countries. We found no beneficial effect in low-income countries.”
“Subgroup analysis on timing of corticosteroids (before or with the first dose of antibiotics versus after the first dose of antibiotics) showed similar results for mortality (RR 0.87 95% CI 0.69 to
1.09 (I2 statistic 52%, random-effects model); RR 0.83, 95% CI 0.55 to 1.26) (Analysis 6.1; Analysis 6.2; Analysis 6.3; Analysis 6.4). For subgroup analyses of severe hearing loss and short-term neurological sequelae, administration after the first dose of antibiotics had slightly more favourable point estimates than studies with early administration of corticosteroids, but there was no significant heterogeneity between subgroups.”