A clinical practice guideline for tuberculous meningitis - 19/08/25

Doi : 10.1016/S1473-3099(25)00364-0

Joseph Donovan, PhD ^a,^b,^{^{†
Contributed equally},}⁎ , Fiona V Cresswell, PhD ^b,^c,^d,^{^{†
Contributed equally}}, Elizabeth W Tucker, MD ^e,^f,^g,^{^{†
Contributed equally}}, Angharad G Davis, MD PhD ^i,^j,^l,^{^{†
Contributed equally}}, Ursula K Rohlwink, PhD ^k,^{^{†
Contributed equally}}, Julie Huynh, PhD ^a,^m,^{^{†
Contributed equally}}, Regan Solomons, ProfPhD ^o,^{^{†
Contributed equally}}, James A Seddon, ProfPhD ^n,^p,^{^{†
Contributed equally}}, Nathan C Bahr, MD ^q, Arjan van Laarhoven, MD PhD ^r, Suzanne T Anderson, PhD ^u, Sanjay K Jain, ProfMD ^f,^g,^h, Felicia C Chow, MD MAS ^v, Sophie Pattison, MSc ^w, James E Scriven, PhD ^x, Gabriela Singh, MSc ^k, Rob E Aarnoutse, Prof ^s, Jan-Willem C Alffenaar, ProfPhD ^y,^z, Sofiati Dian, MD PhD ^aa, Abi Manesh, DM ^ab, Robin Basu Roy, PhD ^l, Varinder Singh, MD ^ac, Ronald van Toorn, ProfPhD ^o, Caryn M Upton, MD ^ad, Reinout van Crevel, ProfPhD ^m,^r, Kelly E Dooley, Prof ^ae, Diana Gibb, ProfMD ^u, David Meya, PhD ^af, Robert J Wilkinson, ProfFMedSci ^i,^j,^p, Ewelina Rogozińska, PhD ^t, Usha K Misra, ProfDM ^ag, Anthony Figaji, ProfPhD ^k, Guy E Thwaites, ProfPhD ^a,^m
^a Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam
^b Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
^c Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK
^d Medical Research Council Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Nakiwogo Road, Entebbe, Uganda
^e Department of Anesthesiology and Critical Care Medicine, Division of Pediatric Anesthesiology and Critical Care Medicine, John Hopkins University School of Medicine, Baltimore, MD, USA
^f Center for Tuberculosis Research, John Hopkins University School of Medicine, Baltimore, MD, USA
^g Center for Infection and Inflammation Imaging Research, John Hopkins University School of Medicine, Baltimore, MD, USA
^h Department of Pediatrics, John Hopkins University School of Medicine, Baltimore, MD, USA
ⁱ The Francis Crick Institute, London, UK
^j Wellcome Discovery Research Platforms in Infection, Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory, South Africa
^k Division of Neurosurgery, Department of Surgery, Neuroscience Institute, University of Cape Town, Observatory, South Africa
^l Queen Mary and Barts Tuberculosis Centre, Queen Mary University London, London, UK
^m Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Oxford University, Oxford, UK
ⁿ Desmond Tutu TB Centre, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
^o Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
^p Department of Infectious Diseases, Imperial College London, London, UK
^q Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
^r Department of Internal Medicine, Radboudumc, Nijmegen, Netherlands
^s Department of Pharmacy, Radboudumc, Nijmegen, Netherlands
^t Meta-Analysis Group, University College London, London, UK
^u MRC Clinical Trials Unit, University College London, London, UK
^v Department of Neurology and Department of Infectious Diseases, University of California, San Francisco, CA, USA
^w UCL Library Services, Library, Culture, Collections and Open Science (LCCOS), University College London, London, UK
^x Department of Microbes, Infection & Microbiomes, School of Infection, Inflammation and Immunology, College of Medicine and Health, University of Birmingham, Birmingham, UK
^y Institute for Infectious Diseases and Sydney Pharmacy School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
^z Westmead Hospital, Department of Pharmacy, Westmead, NSW, Australia
^aa Department of Neurology and Research Center for Care and Control of Infectious Disease, Faculty of Medicine, Universitas Padjadjaran and Hasan Sadikin Hospital, Bandung, Indonesia
^ab Department of Infectious Diseases, Christian Medical College, Vellore, India
^ac National Center for Excellence in Pediatric Tuberculosis, Department of Pediatrics, Lady Hardinge Medical College and Kalawati Saran Children’s Hospital, Bangla Sahib Marg, New Delhi, India
^ad TASK Clinical Research Centre, Cape Town, South Africa
^ae Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
^af Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
^ag TS Misra Medical College, Apollo Medics Super Specialty Hospital and Vivekanand Polyclinic and Institute of Medical Sciences, Lucknow, India

^*Correspondence to: Joseph Donovan, Oxford University Clinical Research Unit, Ho Chi Minh City, 764 Vo Van Kiet, Viet NamOxford University Clinical Research UnitHo Chi Minh CityVo Van Kiet764Viet Nam

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Tuesday 19 August 2025

Summary

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.

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