We conducted a retrospective chart analysis of diarrheal patients with enteric fever and encephalopathy (among survivors and non-survivors) to examine the role of high-dose, intravenous dexamethasone as an adjunct to appropriate antimicrobial therapy in their management. We studied all patients admitted to the Special Care Ward (SCW) of Dhaka Hospital between October 2006 and October 2007 with a diagnosis of encephalopathy in association with enteric fever. Twenty-three cases were identified with three mortalities. All bacterial isolates (Salmonella Typhi and Salmonella Paratyphi) were multi-drug resistant. Survivors were significantly more likely to have received high dose dexamethasone (100% vs 00%; p < 0.001) and had hypoglycemia less often (6% vs 67%; p = 0.045) compared to those who died. The results suggest high dose intravenous dexamethasone, as an adjunct to appropriate antimicrobial therapy, substantially reduces mortality among diarrheal patients presenting with enteric encephalopathy.