RANDOMIZED CONTROLLED TRIAL OF DEXAMETHASONE IN TUBERCULOUS MENINGITIS

Setting: The patients admitted to the Neurology ward of the All India Institute of Medical Sciences Hospital. Objective: To assess the role of dexamethasone as an adjunct to antimicrobial therapy in the treatme nt of tuberculous meningitis. Design: A randomised controlled trial of 47 patients was conducted over a 13-month period. 41 patients complet ed the trial. Patients were stratified into mild, moderate and severe groups and randomly allocated to steroid and non-steroid groups. All p atients received a standardized antituberculosis drug regime. The end point was 3 months, or death if earlier. The evaluation at the end poi nt included survival, resolution of symptoms, sequelae and activities of daily living. Results were analyzed using the Wilcoxon rank sum tes t. Results: The patients in the dexamethasone group fared better. 75% of this group had mild sequelae as opposed to 62% of the control group . Amongst the survivors, those who received dexamethasone sensorium im proved earlier, and there was greater improvement in mental function a nd daily activities. The difference, however, did not reach statistica l significance. Conclusions: Dexamethasone appears useful as an adjunc t in the treatment of tuberculous meningitis especially in patients wh o have severe disease. The results need confirmation by a larger trial .