Which corticosteroid is commonly used as adjunctive therapy for TB meningitis?

• A. Dexamethasone.
• B. Prednisone.
• C. Hydrocortisone.
• D. Fluticasone.

Answer: (A)

In TB meningitis, dampening the inflammatory response in the meninges is crucial because excessive inflammation worsens edema, raises intracranial pressure, and can lead to brain injury. Dexamethasone is the preferred adjunctive corticosteroid because its high lipid solubility allows excellent penetration into the CNS, enabling it to effectively reduce meningeal inflammation. It provides potent anti-inflammatory effects with less mineralocorticoid activity, and clinical trials have shown that using it alongside anti-TB therapy lowers mortality and neurological complications across severities of TB meningitis. Other steroids like prednisone or hydrocortisone are less favored for this condition due to weaker CNS penetration or less robust evidence in TB meningitis, and inhaled fluticasone isn’t suitable for systemic CNS inflammation. When adjunctive therapy is needed for TB meningitis, dexamethasone is the commonly used choice.