Update on the Treatment of Pediatric Tuberculous Meningitis.

At the 2018 high-level United Nations meeting on tuberculosis (TB), treatment targets were set for the 5-year period 2018–2022. These targets included the treatment of 3.5 million children. However, by 2020 only 41% of this target had been achieved with further stasis highly likely due to the havoc wreaked by the COVID-19 pandemic on access to healthcare. Tuberculous meningitis (TBM), is considered the most devastating manifestation of TB, with the peak incidence in the vulnerable early childhood age group, coinciding with critical brain development. Early diagnosis in childhood is difficult due to nonspecific clinical features and the paucibacillary nature of the disease complicating cerebrospinal fluid (CSF) mycobacterial confirmation, resulting in delayed diagnosis and treatment. Untreated, TBM is uniformly fatal, and even when treated, the neurological sequelae can be severe. Unfortunately, the evidence to guide treatment is limited. We present a summary of existing pediatric TBM treatment, recent updates, clinical trials which may potentially inform antituberculous dosing regimens, and practical clinical recommendations.