Drug resistant tuberculous meningitis: A neglected foe in ending tuberculosis epidemic

Treatment outcomes of tuberculous meningitis (TBM), a disease with high mortality depends on early diagnosis and management. The global and regional burden of TBM and drug resistant TBM (DRTBM) are largely unknown. DRTBM is associated with poorer treatment outcomes. The wider use of latest rapid diagnostic molecular tests including nucleic acid amplification tests paves way for better management of TBM. There is limited knowledge on the efficacy of antituberculous drugs in DRTBM, especially the newer drugs regarding their ability to cross the blood brain barrier and its local bioavailability. Optimal regimen and duration of treatment for DRTBM that is resistant to one or more drugs is largely an unexplored area. Simpler point of care diagnostic tests for Mycobacterium Tuberculosis detection and drug susceptibility testing, concentration of drugs used for DRTBM in CSF , optimal regimen and duration of treatment are some of the priority areas of research in DRTBM. • Diagnostic, management challenges of drug resistant tuberculous meningitis are many. • Drugs with good central nervous system penetrability needed for its management. • Optimal regimen and duration with good efficacy is needed. • Point of care diagnostics for M. tuberculosis confirmation and resistance detection.