Treatment of Tuberculous Meningitis in Patients Aged 19 or Younger Without HIV
Tuberculous meningitis (TBM) in children and adolescents aged 19 years or younger who are HIV-negative represents a distinct clinical population with specific management considerations. Both age and HIV status directly inform the treatment approach for this group.
Clinical Scenario
This protocol applies when all of the following are present:
Age 19 years or younger
Tuberculous meningitis
HIV co-infection absent
Approach to Management
In refractory presentations where initial therapy does not adequately control inflammatory symptoms, the protocol describes a role for immunomodulating agents — including anti-TNF biologicals — in select cases.
References
DOI: 10.1016/S1473-3099(25)00364-0
- For children and adolescents aged 19 years or younger with drug-susceptible tuberculous meningitis, WHO recently recommended that a 6-month regimen (isoniazid 15–20 mg/kg per day, rifampicin 22·5–30 mg/kg per day, and pyrazinamide 35–45 mg/kg per day, and the substitution of ethambutol with ethionamide at 17·5–22·5 mg/kg per day) can be used instead of the 12-month standard regimen.
- Is there HIV co-infection?
- If corticosteroids do not control symptoms, then small case-series and case reports have described the use of anti-TNF biologicals (eg, infliximab), thalidomide, or anakinra.
- A retrospective cohort study in India reported adjunctive infliximab (10 mg/kg for one to three doses, 4 weeks apart) was safe and effective in treating severe inflammatory complications of tuberculous meningitis.
- Observational studies in South African children have suggested that adjunctive thalidomide (2–5 mg/kg per day) was safe and effective in treating tuberculous mass lesions and optochiasmatic arachnoiditis.