**8.3 New agents**


The treatment of tuberculous meningitis is a strictly supervised treatment (DOTS) for 12 months, intensive (2 months) + continuous phase (10 months). Why the treatment is so long, till routine DOTS regimen is 6 months? Because large doses are required to penetrate the blood–brain barrier and to prevent recidivism rates.

Children with TBM should be hospitalized, preferably for the first 2 months or until clinical stabilization. In intensive phase four drugs (RHZE/S) are recommended for 2 months and in continuation phase, isoniazid and rifampicin recommended for 10 months.

In recent years, resistance to antituberculosis drugs is increasing, and multidrugresistant tuberculosis (MDR-TB) poses serious treatment problems. Clinical trials of examining the use of high-dose rifampicin and/or fluoroquinolones are likely to report in the near future [45].

HIV/AIDS infection significantly complicates the treatment of TBM by high prevalence of drug side effects, high risk of drug–drug interaction, reducing the absorption of antiviral drugs and risk of developing immune reconstitution syndrome (IRIS). In HIV seropositive patients, it is recommended to start the anti-tuberculosis treatment first and then, after 2–8 weeks, the antiviral one.
