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S.Priyadharshini
Antitubercular therapy
Steroids
Symptomatic therapy
 The child is hospitalised preferably for first 2 months or until they are
clinically stabilized.
 Short course chemotherapy not recommended.
 Total duration is 12 months.
Initiation phase HRZE 2 months
Continuation phase HR 10 months
DRUGS DOSAGE
Isoniazid (H) 5 mg/kg/day
Rifampicin (R) 10 mg/kg/day
Pyrazinamide (Z) 30mg/kg/day
Ethambutol (E) 15-20mg/kg/day
Streptomycin (S) 30-40mg/kg/day
 In acute phase of illness, parenteral dexamethasone
(0.15mg/kg/dose) is given.
 Then switched over to oral prednisolone.
 Oral steroids continued for 6 weeks and tapered over
next 2 weeks.
 Rationale
Steroids reduce the intensity of cerebral edema,
arachnoiditis,fibrosis and spinal block.
Raised intracranial pressure- 20%
Mannitol i.v 0.5 g/kg every 4-6 hr for
maximum 6 doses.
Convulsions-Diazepam i.v followed by
phenytoin.
Dyselectrolytemia-Maintenance fluids.
Hydrocephalus and persistent
decerebration-Ventriculocaval shunt.
Intellectual
disability
Seizures Motor and cranial
nerve deficits
Hydrocephalus Optic atrophy Arachnoiditis
Subdural
effusion
Hyponatremia Tuberculoma
 BCG vaccination offers a protective effect (approx.64%)against TBM.
 Imporvement in weight for age was associated with decreased risk of
the disease.
 Poorer in younger children.
 Untreated cases die within 4-8 weeks
Stage Mortality Neurological deficits
Stage 1 Recovery -
Stage 2 20-25% 25% of survivors
Stage 3 50% All survivors
Duration of ATT is for 12 months
Indications for steroids in TB
TB Meningitis
Massive pleural effusions
Pericarditis and pericardial effusions
Presenting with hydrocephalus as a complication-suspect TB
Meningitis
tuberculous Meningitistreatment and complications

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tuberculous Meningitis treatment and complications

  • 3.  The child is hospitalised preferably for first 2 months or until they are clinically stabilized.  Short course chemotherapy not recommended.  Total duration is 12 months. Initiation phase HRZE 2 months Continuation phase HR 10 months
  • 4. DRUGS DOSAGE Isoniazid (H) 5 mg/kg/day Rifampicin (R) 10 mg/kg/day Pyrazinamide (Z) 30mg/kg/day Ethambutol (E) 15-20mg/kg/day Streptomycin (S) 30-40mg/kg/day
  • 5.  In acute phase of illness, parenteral dexamethasone (0.15mg/kg/dose) is given.  Then switched over to oral prednisolone.  Oral steroids continued for 6 weeks and tapered over next 2 weeks.  Rationale Steroids reduce the intensity of cerebral edema, arachnoiditis,fibrosis and spinal block.
  • 6. Raised intracranial pressure- 20% Mannitol i.v 0.5 g/kg every 4-6 hr for maximum 6 doses. Convulsions-Diazepam i.v followed by phenytoin. Dyselectrolytemia-Maintenance fluids. Hydrocephalus and persistent decerebration-Ventriculocaval shunt.
  • 10.  BCG vaccination offers a protective effect (approx.64%)against TBM.  Imporvement in weight for age was associated with decreased risk of the disease.
  • 11.  Poorer in younger children.  Untreated cases die within 4-8 weeks Stage Mortality Neurological deficits Stage 1 Recovery - Stage 2 20-25% 25% of survivors Stage 3 50% All survivors
  • 12. Duration of ATT is for 12 months Indications for steroids in TB TB Meningitis Massive pleural effusions Pericarditis and pericardial effusions Presenting with hydrocephalus as a complication-suspect TB Meningitis