In children the benefit of a combination therapy with dexamethasone and ceftriaxone has only been proven in the reduction of permanent hearing loss after Haemophilus influenzae type b meningitis, a pathogen that today is virtually eradicated in regions that implemented the vaccination. Furthermore, the beneficial effects of dexamethasone administration in meningitis have been challenged repeatedly. A recent prospective study and two meta-analyses show conflicting results considering the benefit of adjuvant corticosteroid treatment for neurological outcome in children with acute bacterial meningitis. Furthermore, adjunctive corticosteroid treatment does not seem to benefit patients with acute bacterial meningitis in developing countries. Even more worrying are results in experimental meningitis, which indicate that dexamethasone might lead to neuronal injury.