In TB meningitis, what adjunct therapy is typically included?

• A. Use anticonvulsants as the sole adjunct.
• B. Include corticosteroids (e.g., dexamethasone) alongside anti-TB drugs.
• C. Avoid any adjunct therapy.
• D. Only use nonsteroidal anti-inflammatory drugs.

Answer: (B)

Inflammation control is crucial in TB meningitis because the meningeal inflammation and resulting vasculitis drive brain edema, raised intracranial pressure, and infarcts, all of which worsen outcomes. Giving corticosteroids, such as dexamethasone, as an adjunct to anti-TB therapy reduces this inflammatory response, lowers intracranial pressure, and improves survival and neurologic outcome, especially in the early weeks of treatment. Start corticosteroids promptly with anti-TB drugs and taper over several weeks as the patient improves. Using anticonvulsants alone doesn’t address the inflammatory process; avoiding adjunct therapy misses a proven benefit; and relying only on NSAIDs does not provide the necessary anti-inflammatory effect.