- Isoniazid, rifampin, pyrazinamide, streptomycin and to some extent, ethambutol in high doses, happen to be the most suitable of antimicrobial agents utilized in treating TB meningitis. This is because all these agents can easily enter the cerebrospinal fluid in spite of the meningeal swelling. Second in the line of treatment drugs would include cycloserine, ethionamide, aminoglycosides, PAS, thiacetazone and capreomycin. Newer compounds used for treating TB meningitis are isepamicin and oxazolidinone. There are a few fluoroquinolone antibiotics such as ofloxacin, levofloxacin, and ciprofloxacin and rifapentine, a newly developed rifamycin, which have been found beneficial in the healing of TB meningitis. These result in enhanced treatment against dynamic and dormant TB.
The recent volume addition in the knowledge base of mycobacterial pathogenesis will soon possibly result in the development of powerful and effective drugs to combat dormant illness, which will also probably fight against the occurrence of disease lingering. Due to the extreme concentration of the inflammation and fibrotic responses at the site of meninges, certain adjunctive corticosteroids, along with regular anti-tuberculous rehabilitation, is suggested for patients suffering from TB meningitis. However, this might come with heightened pressure inside the cranium, changed awareness, spinal jams and even tuberculous encephalopathy.
Healing of tuberculoma includes steroids in elevated dosage and continuous antituberculous treatment for a long time. In some cases where arachnoiditis has made TB meningitis more complicated, intrathecal application of hyaluronidase, has been found beneficial too. No matter which method of treatment is being used, any routine for treating TB meningitis should include several drugs or antitubercular agents, which the mycoplasma can readily receive. - TB meningitis patients under treatment, with proof of obtrusive hydrocephalus and neurological degeneration, should be scheduled for placement of a ventricular pump or ventriculoatrial or ventriculoperitoneal shunt as soon as possible. Timely surgery of this kind is known to lead to better results, especially in patients with low neurological insufficiency.
- Young patients with TB meningitis are known to respond well, minus obvious hepatotoxicity and with a reduced hazard of degeneration, to half a year's treatment with anti-TB medicines in elevated dosage. They should be subjected to a year of treatment with a blend of adjunctive corticosteroids, which bring down the dangerous effects of swelling by destroying organisms, along with antibiotic drugs. By this time, bacterial cure should set in. Therapeutic methods that lower the hazard for thrombosis could be possibly useful in treating children with TB meningitis.
- Though there are many contradictory reports regarding the time taken for treatment, the traditional, most commonly seen therapy procedure takes between half and three quarters of a year, while in extreme cases, the same might take up to about two years.