In sub-Saharan Africa bacterial meningitis is common and carries a high mortality, Steroid adjuvant therapy reduces mortality in aduhs in the developed world but has not been adequately tested in developing countries or in the context of advanced HIV. The mechanism of action of adjunctive steroids in bacterial meningitis is incompletely understood but may involve down regulation of the host's proinflammatory cytokine response. Bacterial meningitis in this setting presents late and is strongly associated with HIV co-infection. Dexamethasone adjuvant therapy for bacterial meningitis in aduhs did not reduce mortality or morbidity. Intramuscular ceftriaxone was not inferior to intravenous ceftriaxone for the treatment of bacterial meningitis. Cytokine expression was unaffected by the use of steroid adjuvant therapy.