Role of Dexamethasone in Tuberculous Meningitis

Rationale and Evidence

The American Thoracic Society recommends adjunctive dexamethasone therapy for all patients with tuberculous meningitis, as it reduces mortality and neurological sequelae, particularly in those with decreased level of consciousness 1, 2
Tuberculous meningitis is associated with high mortality and morbidity despite prompt initiation of adequate antituberculous chemotherapy 1
Six of eight controlled trials have shown benefit of corticosteroid therapy in terms of survival, frequency of sequelae, or both 1
The greatest benefit was observed in patients with Stage II disease (lethargic) with mortality of 15% in the dexamethasone group versus 40% in the control group (p<0.02) 1

For adults and children weighing ≥25 kg: 12 mg/day initially, and for children weighing <25 kg: 8 mg/day initially, with the initial dose given for 3 weeks, then decreased gradually over the following 3 weeks 1

The recommended regimen includes an initial 3 weeks at full dose followed by 3 weeks of gradual dose reduction 1