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  • Title: Duration of anti-tubercular treatment in tuberculous meningitis: challenges and opportunity.
    Author: Prasad K, Sahu JK.
    Journal: Neurol India; 2010; 58(5):723-6. PubMed ID: 21045495.
    Abstract:
    BACKGROUND: The duration of anti-tuberculous therapy in tuberculous meningitis is controversial. There is variation in recommendations by different societies and expert groups on this issue. OBJECTIVE: To determine the strength of evidence for short-term therapy in tuberculous meningitis through review of literature and critical appraisal. MATERIALS AND METHODS: Cochrane CENTRAL (Issue 4, 2010), TRIP database, and PubMed (from 1966 to present) were searched for relevant papers with keywords 'meningeal tuberculosis' and tuberculous meningitis' combined with 'chemotherapy'. A critical appraisal of a systematic review was done using standard criteria. RESULTS: A total of 10 relevant papers were identified. All papers were included in a systematic review. The systematic review did not specify study design of studies to be included, had only case series but no randomised controlled trial, and unclear definition of endpoints. CONCLUSIONS: The evidence base for short-term therapy for tuberculous meningitis is weak. There is a need to conduct a randomised controlled trial with non-inferiority hypothesis of adequate sample size with well-defined end points and adequate follow-up. This is a challenge as well as opportunity for Indian neurologists.
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