**9. Adjuvant therapy with corticosteroids in TBM**

Corticosteroids (dexamethasone, prednisone and methilprednisolon) are recommended for all children and adults with TB meningitis [46]. Patients with an average form of the disease will receive dexamethasone 0.3 mg/kg/day x 1 week, 0.2 mg/kg/day x 1 week after which oral treatment for 4 weeks. Patients with severe forms of TBM will receive for 4 weeks decreasing dexamethasone 0.4 mg/kg/day x 1 week, 0.3 mg/kg/day x 1 week, 0.2 mg/kg/day x 1 week, 0.1 mg/kg/day x 1 week, then oral treatment with the same preparation for another 4 weeks [47]. In HIV-positive patients, corticosteroid therapy is administered in the absence of life-threatening opportunistic infections. A study conducted in Vietnam in patients with TBM [46], randomized, double-blind, placebo-controlled trial (n=545), shows that dexamethasone is associated with a reduced risk of death or severe neurosequelae at 9 months, but does not prevent severe neurological disability [46]. It has been postulated that dexamethasone reduces the deleterious effects of the immune response and also reduces the incidence of hydrocephalus and brain infarction [32, 47].
