Prevailing practices in the treatment of tuberculous meningitis (TBM): a cross-sectional study

Tuberculosis (TB) of the central nervous system accounts for about 1% of all cases of TB and around 10% of extrapulmonary TB.1 There are differing recommendations for treatment of tuberculous meningitis (TBM).1–3 This is due to the limited evidence on the optimal choice and duration of antitubercular treatment (ATT). Most data on treating TBM have been extrapolated from pulmonary TB.4 Although the current practice guidelines recommend treatment for TBM for 9 months,2 the duration of treatment varies across neurologists and physicians managing the disease. The intensive phase consists of 2 months of four-drug ATT and continuation phase consists of 7 months of two-drugs ATT. Most neurologists from high-disease-burden areas prefer to give aggressive treatment for early improvement. This notion is limited to expert opinions. It is based on the anticipation that incomplete treatment may lead to increased death, relapse and neurological sequelae. On the other hand, prolonged treatment adds to adverse effects of medications, poor compliance, economic burden and drug resistance.