• 1.

    Prasad K, Singh MB, Ryan H, 2016. Corticosteroids for managing tuberculous meningitis. Cochrane Database Syst Rev 4: 164.

  • 2.

    Thwaites GE et al. 2004. Dexamethasone for the treatment of tuberculous meningitis in adolescents and adults. N Engl J Med 351: 17411751.

  • 3.

    Marais S, Thwaites G, Schoeman JF, Torok ME, Misra UK, Prasad K, Donald PR, Wilkinson RJ, Marais BJ, 2010. Tuberculous meningitis: a uniform case definition for use in clinical research. Lancet Infect Dis 10: 803812.

    • Search Google Scholar
    • Export Citation
  • 4.

    Chiang SS, Khan FA, Milstein MB, Tolman AW, Benedetti A, Starke JR, Becerra MC, 2014. Treatment outcomes of childhood tuberculous meningitis: a systematic review and meta-analysis. Lancet Infect Dis 14: 947957.

    • Search Google Scholar
    • Export Citation
  • 5.

    Wang JT, Hung CC, Sheng WH, Wang JY, Chang SC, Luh KT, 2002. Prognosis of tuberculous meningitis in adults in the era of modern antituberculous chemotherapy. J Microbiol Immunol Infect 35: 215222.

    • Search Google Scholar
    • Export Citation
  • 6.

    Hosoglu S et al. 2002. Predictors of outcome in patients with tuberculous meningitis. Int J Tuberc Lung Dis 6: 6470.

  • 7.

    Karstaedt AS, Valtchanova S, Barriere R, Crewe-Brown HH, 1998. Tuberculous meningitis in South African urban adults. QJM 91: 743747.

  • 8.

    Lamprecht D, Schoeman J, Donald P, Hartzenberg H, 2001. Ventriculoperitoneal shunting in childhood tuberculous meningitis. Br J Neurosurg 15: 119125.

    • Search Google Scholar
    • Export Citation
  • 9.

    Kalita J, Misra UK, Ranjan P, 2007. Predictors of long-term neurological sequelae of tuberculous meningitis: a multivariate analysis. Eur J Neurol 14: 3337.

    • Search Google Scholar
    • Export Citation
  • 10.

    Sharma SK et al. 2017. Index-TB guidelines: guidelines on extrapulmonary tuberculosis for India. Indian J Med Res 145: 448463.

  • 11.

    World Health Organization, 2017. Guidelines for Treatment of Drug-Susceptible Tuberculosis and Patient Care, 2017 Update. Available at: http://apps.who.int/iris/bitstream/10665/255052/1/9789241550000-eng.pdf?ua=1. Accessed September 17, 2018.

    • Search Google Scholar
    • Export Citation
  • 12.

    Malhotra HS, Garg RK, Singh MK, Agarwal A, Verma R, 2009. Corticosteroids (dexamethasone versus intravenous methylprednisolone) in patients with tuberculous meningitis. Ann Trop Med Parasitol 103: 625634.

    • Search Google Scholar
    • Export Citation
  • 13.

    Chotmongkol V, Jitpimolmard S, Thavornpitak Y, 1996. Corticosteroid in tuberculous meningitis. J Med Assoc Thai 79: 8390.

  • 14.

    Schoeman JF, Van Zyl LE, Laubscher JA, Donald PR, 1997. Effect of corticosteroids on intracranial pressure, computed tomographic findings, and clinical outcome in young children with tuberculous meningitis. Pediatrics 99: 226231.

    • Search Google Scholar
    • Export Citation
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 

 

 

Intravenous Steroid Days and Predictors of Early Oral Steroid Administration in Tuberculous Meningitis: A Retrospective Study

View More View Less
  • 1 Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India;
  • | 2 Department of Biostatistics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
Restricted access

Intravenous (IV) dexamethasone is recommended for 14 days in stage 1 and 28 days in stage 2/3 tuberculous meningitis (TBM). We used a different steroid protocol. We shifted TBM patients to oral steroids after 48 hours of sustained improvement on IV steroids (oral group). Patients who worsened after shifting to oral steroids were reinitiated on IV steroids. Once they showed a consistent improvement for 48 hours, the IV steroids were overlapped with oral steroids for 7–10 days to taper off IV steroids (overlap group). We compared total IV steroid days in our patients with the recommended treatment and identified predictors that favored the oral group. This was a retrospective study. We included 98 patients with TBM (66 in the overlap group and 32 in the oral group) from January 2013 to July 2018. The median IV steroid days were 9 days (interquartile range of 4–12; 2–3.5 days in the oral group and 10–11.5 days in the overlap group). The mortality rate was 6.1%. The logistic regression model showed that TBM patients with basal exudate, tuberculoma, and modified Rankin scale (mRS) < 3 had a higher probability for going to the oral group. We conclude that total IV steroid days can be reduced in TBM patients by our method of steroid use. Presence of basal exudates and tuberculoma may favor early shifting from IV to oral steroid, whereas higher mRS may require a relatively longer course of IV steroid.

    • Supplemental Materials (ODT 157 KB)
    • Supplemental Materials (MS Word 33 KB)
    • Supplemental Materials (MS Word 32 KB)
    • Supplemental Materials (MS Word 29 KB)

Author Notes

Address correspondence to Vimal Kumar Paliwal, Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Rd., Lucknow 226014, India. E-mails: dr_vimalkpaliwal@rediffmail.com or drvimalkpaliwal@gmail.com

Authors’ addresses: Vimal Kumar Paliwal, Animesh Das, and Sucharita Anand, Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India, E-mails: dr_vimalkpaliwal@rediffmail.com, animeshdas05@gmail.com, and sucharita.anand@gmail.com. Prabhakar Mishra, Department of Biostatistics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India, E-mail: drpmishra@sgpgi.ac.in.

These authors contributed equally to this work.

Save