Tuberculous meningitis is a serious form of tuberculosis affecting the meninges covering the brain and spinal cord. The clinical outcome is poor even when treated with conventional antituberculous drugs. Corticosteroids are commonly used in addition to antituberculous drugs for treating the condition. They help reduce swelling and congestion of the meninges, and thus decrease pressure inside the brain and the attendant risk of death or disabling residual neurological deficit among survivors. This review identified seven trials involving 1140 people that evaluated either dexamethasone or prednisolone given in addition to antituberculous drugs; only one trial was of high quality. Overall, the trials showed that corticosteroids help reduce the risk of death or a risk of death or disabling residual neurological deficit. Only one trial evaluated the effects of corticosteroids in HIV-positive people, but the effects were unclear. Given the results of the review, all HIV-negative people with tuberculous meningitis should receive corticosteroids, but more trials are needed in HIV-positive people.
Corticosteroids for managing tuberculous meningitis
21 January 2009
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