Treatment of Tuberculous Meningitis in Adults (Age 18 and Older) Without HIV Co-infection

This protocol covers the management of tuberculous meningitis in hospitalised adults aged 18 years or older who do not have HIV co-infection — a population for which evidence strength and recommendations differ from those with HIV.

The clinical scenario is adults requiring hospital-based treatment for tuberculous meningitis in the absence of HIV co-infection. Evidence in this group is of high certainty, with a strong recommendation for the approach — contrasting with the case-by-case guidance that applies when HIV co-infection is present.

In certain complications of this condition, corticosteroid therapy plays a role — the specific circumstances, agents, and how they are adjusted are detailed in the full protocol.

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References

DOI: 10.1016/S1473-3099(25)00364-0

Population: adults in hospital requiring treatment for

Is there HIV co-infection?

high certainty of evidence, strong recommendation for use in individuals without HIV; high certainty of evidence, weak recommendation for use in people living with HIV so the decision to use should be made on a case-by-case basis

Increase or prolong corticosteroids; in refractory cases consider other immunomodulating agents (eg, anti-TNF, thalidomide, or anakinra)

Expert opinion recommends using high-dose corticosteroids initially (eg, dexamethasone at 0·4 mg/kg per day), tapering slowly according to symptom resolution.

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