The use of dexamethasone in preventing ocular complications in tuberculous meningitis

Abstract

Twenty-seven patients with tuberculous meningitis (TBM) were treated with ethambutol, isonicotinic acid hydrazide, streptomycin and dexamethasone and 28 were treated with triple anti-tuberculous drugs only. Only two of the patients to whom steroids were given developed ocular complications as compared to seven of those not receiving dexamethasone. High dose dexamethasone apparently prevents optic atrophy in TBM. Controlled double-blind studies with and without dexamethasone are needed to confirm this postulation.

Approach to the diagnosis and management of tuberculous meningitis

“…No trial demonstrated significantly worse outcomes with the use of adjunctive corticosteroids in patients with tuberculous meningitis. In fact, the data suggested earlier clinical improvement [33,40], fewer neurologic sequelae [33,[38][39][40][41], and improved survival [34,37,39,41]. These benefits may be most likely observed in patients with spinal block, as well as in patients with intermediate-stage disease, as evidenced by two of the trials [34,39] that stratified patients by disease severity on study entry.…”

“…By far, most studies have evaluated the use of corticosteroids, since persistent central nervous system inflammation despite antimicrobial therapy is often responsible for the increased morbidity and mortality that is observed in patients with tuberculous meningitis [1,32]. To date, there have been nine controlled trials (resulting in 10 papers) that have examined the role of adjunctive corticosteroids in the treatment of tuberculous meningitis (Table 4) [33][34][35][36][37][38][39][40][41][42]. These trials differed in the severity of illness in the patients studied, patient age, the dose and form of corticosteroid used, and the outcomes analyzed.…”

Approach to the Diagnosis and Management of Tuberculous Meningitis

“…No trial demonstrated significantly worse outcomes with the use of adjunctive corticosteroids in patients with TBM. In fact, most data suggested earlier clinical improvement [35,42], fewer neurologic sequelae [35,[40][41][42]44], and/or improved survival [36,39,41,44,46].…”

“…By far, most studies have evaluated the use of corticosteroids, because persistent CNS inflammation despite antimicrobial therapy is believed to be responsible for much of the increased morbidity and mortality observed in patients with TBM [1]. To date, 12 controlled trials have examined the role of adjunctive corticosteroids in the treatment of TBM (Table 2) [35][36][37][38][39][40][41][42][43][44][45][46]. These trials differ in the severity of illness of the patients studied, patient age, outcomes analyzed, and the dose, form, and duration of corticosteroid therapy.…”

The ERS-endorsed official ATS/CDC/IDSA clinical practice guidelines on treatment of drug-susceptible tuberculosis

“…The role of adjunctive corticosteroid therapy in the treatment of TB meningitis has been investigated by numerous studies [52][53][54][55][56][57][58][59][60][61][62][63][64], and the updated systematic review conducted in support of the guidelines showed a mortality benefit from the use of adjuvant corticosteroids. Therefore, the guidelines recommend adjunctive corticosteroid therapy with dexamethasone or prednisolone tapered over 6-8 weeks for patients with TB meningitis (PICO question 8).…”