A decade of drug-resistant tuberculous meningitis: A wake-up call for patient-centric therapy

On analyzing the drug susceptibility profile of 151 clinical isolates collected from patients of tuberculous meningitis (TBM) over 10 years, we reflect on few lessons learnt from the trend of susceptibility profile - drug resistance was not uncommon, fluoroquinolone resistance was observed even among otherwise susceptible isolates and hetero-resistance was observed against rifampicin, isoniazid and also fluoroquinolones. In the midst of widening gap between incidence of drug resistant TBM and availability of effective drugs, our data suggests that universal testing for drug resistance, careful choice of drugs having optimal penetration and individualized therapy should form important pillars of TBM management.