Treatment of tuberculous meningitis

Abstract

Summary The problem of treatment as defined by the pathology of the fatal case is outlined. The principles of successful treatment are defined as: (1) the early institution of appropriate chemotherapy; (2) free access of the chosen antibiotics to all sites of infection; (3) maintenance of an adequate concentration of the antibiotics in the CSF for a sufficient length of time; and (4) treatment of the systemic infection. The application of each of these principles in the management of tuberculous meningitis is considered. The importance of early diagnosis is emphasized, and certain clinical aspects of the disease are discussed. A regime of treatment is described in which both streptomycin and isoniazid are given both systemically and intrathecally. The use of intrathecal PPD is also briefly discussed. The limitations of this form of treatment are defined, and the dangers inherent in the use of PPD are emphasized. The general measures required are also outlined. The relative merits of combined intrathecal and systemic medication, as opposed to systemic alone, are briefly discussed, as is the possible place of cortisone in treatment.