What is the treatment for tuberculous meningitis?

Updated: Jul 16, 2019
  • Author: Rodrigo Hasbun, MD, MPH; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

Treatment of tuberculous meningitis with a combination of first-line drugs is advocated. The selection depends on the resistance pattern in the community and the results of susceptibility testing (once available). Isoniazid and pyrazinamide attain good CSF levels (approximating blood levels). Rifampin penetrates the blood-brain barrier less efficiently but still attains adequate CSF levels. Ethambutol and streptomycin may also be part of combination therapy.

The dosages of drugs for tuberculous meningitis are similar to those used for pulmonary tuberculosis, as follows:

  • Isoniazid 300 mg/day

  • Rifampin 600 mg/day

  • Pyrazinamide 15-30 mg/kg/day

  • Ethambutol 15-25 mg/kg/day

  • Streptomycin 7.5 mg/kg every 12 hours

The recommended duration of treatment is 9-12 months. [44]


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