Tuberculous Meningitis: Diagnosis and Treatment Overview

Table 1

Recommended standard treatment regimen for drug-susceptible TBM.

Treatment phase and anti-TB agent	Recommended dose (mg/kg/day)	Maximum dose (mg/day)	Potential side effects	Duration of treatment
Isoniazid	5–10	300	hepatotoxicity peripheral neuropathy	Minimum of 9 months
Rifampin	10	450 (<50 kg); 600 (≥50 kg)	hepatotoxicity, rash, flu-like syndrome, and multiple drug interactions.	Minimum of 9 months
Pyrazinamide	25–30	1500 (<50 kg); 2000 (≥50 kg)	hepatotoxicity, arthralgia, gastrointestinal upset, anorexia, and photosensitization of the skin	2 months
Streptomycin (IM)*	15 in adults; (30 in children)	1000	nephrotoxicity, ototoxicity, and vestibular toxicity	2 months
Ethambutol*	15–20	1600 in adults; (1000 in HIV (−) and 2500 in HIV (+) children)	optic neuritis, peripheral neuritis, arthralgia, and gastrointestinal upset	2 months

*For empiric induction treatment for presumed drug-susceptible M. tuberculosis, either streptomycin or ethambutol is recommended as the fourth agent.