Randomized controlled trial of dexamethasone in tuberculous meningitis.
METHODS
The patients admitted to the Neurology ward of the All India Institute of Medical Sciences Hospital.


OBJECTIVE
To assess the role of dexamethasone as an adjunct to antimicrobial therapy in the treatment of tuberculous meningitis.


METHODS
A randomised controlled trial of 47 patients was conducted over a 13-month period. 41 patients completed the trial. Patients were stratified into mild, moderate and severe groups and randomly allocated to steroid and non-steroid groups. All patients received a standardized antituberculosis drug regime. The end point was 3 months, or death if earlier. The evaluation at the end point included survival, resolution of symptoms, sequelae and activities of daily living. Results were analysed using the Wilcoxon rank sum test.


RESULTS
The patients in the dexamethasone group fared better. 75% of this group had mild sequelae as opposed to 62% of the control group. Amongst the survivors, those who received dexamethasone sensorium improved earlier, and there was greater improvement in mental function and daily activities. The difference, however, did not reach statistical significance.


CONCLUSIONS
Dexamethasone appears useful as an adjunct in the treatment of tuberculous meningitis especially in patients who have severe disease. The results need confirmation by a larger trial.
Kumarvelu
S
S
Department of Neurology, All India Institute of Medical Sciences, New Delhi.
Prasad
K
K
Khosla
A
A
Behari
M
M
Ahuja
G K
GK
D000293:Adolescent; D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000627:therapeutic use; D002648:Child; D003907:Dexamethasone / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D014390:Tuberculosis, Meningeal / Q000134:cerebrospinal fluid / Q000188:drug therapy* / Q000401:mortality
D000995:Antitubercular Agents; D003907:Dexamethasone