A systematic review and meta-analysis of steroid use for treatment of TB meningitis

<sec><title>BACKGROUND</title>TB meningitis (TBM) is the most severe form of extra-pulmonary TB. This study evaluated the efficacy and safety of adjunctive steroid therapy in TBM.</sec><sec><title>METHODS</title>We searched PubMed/MEDLINE, Embase, and Cochrane CENTRAL for controlled trials of steroids in TBM. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated for mortality, neurological complications, functional recovery, and adverse events.</sec><sec><title>RESULTS</title>Fourteen trials with 2,028 patients were included. Steroids reduced mortality in adults (RR = 0.83; 95% CI: 0.72–0.95) but not in children (RR = 0.68; 95% CI: 0.36–1.29). No significant benefit was seen for neurological complications (RR = 1.03; 95% CI: 0.74–1.44) or functional recovery (RR = 1.16; 95% CI: 0.86–1.57). Results were consistent across steroid types, doses, and routes.</sec><sec><title>CONCLUSION</title>Adjunctive steroids reduce mortality in adult TBM but not in children, nor do they improve neurological or functional outcomes.</sec>