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A clinical practice guideline for tuberculous meningitis
Joseph Donovan1, Fiona V Cresswell2, Elizabeth W Tucker3
1Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam; Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK.
Abstract:
Tuberculous meningitis is the most severe form of tuberculosis, causing death or disability in around half of those affected. There are no up-to-date international guidelines defining its optimal management. Therefore, the Tuberculous Meningitis International Research Consortium conducted a systematic review of available evidence to address key management questions and to develop practice guidance. The consortium includes representatives from India, Indonesia, South Africa, Uganda, Viet Nam, Australia, the Netherlands, the UK, and the USA. Questions were developed using the Population, Intervention, Comparator, Outcome (PICO) format for tuberculous meningitis diagnosis, anti-tuberculosis chemotherapy, adjunctive anti-inflammatory therapy, and neurocritical and neurosurgical care. A Grading of Recommendations, Assessment, Development and Evaluations approach was used to assess the certainty (or quality) of evidence and establish the direction and strength of recommendations for each PICO-based question. We provide evidence-based recommendations for the optimal treatment and diagnosis of tuberculous meningitis, alongside expert opinion. We expose substantial knowledge and evidence gaps, thereby highlighting current research priorities.
Insights
Tuberculous meningitis management lacks current international guidelines. This systematic review provides evidence-based recommendations and identifies critical research gaps for this severe form of tuberculosis.
Area of Science:
- Infectious Diseases
- Neurology
- Public Health
Background:
- Tuberculous meningitis is a severe form of tuberculosis with high mortality and disability rates.
- Current international guidelines for tuberculous meningitis management are outdated.
- Optimal diagnosis and treatment strategies are urgently needed.
Purpose of the Study:
- To conduct a systematic review of evidence for tuberculous meningitis management.
- To develop practice guidance for diagnosis, chemotherapy, and supportive care.
- To identify knowledge and evidence gaps for future research.
Main Methods:
- Systematic review using Population, Intervention, Comparator, Outcome (PICO) format.
- Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach for evidence quality.
- Inclusion of international consortium representatives.
Main Results:
- Evidence-based recommendations for tuberculous meningitis diagnosis and treatment.
- Expert opinion integrated into practice guidance.
- Identification of substantial knowledge and evidence gaps.
Conclusions:
- There is a critical need for updated international guidelines for tuberculous meningitis.
- The systematic review provides a foundation for optimal patient care.
- Future research priorities are highlighted to address current evidence deficits.
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