Does adjunctive corticosteroid and aspirin therapy improve the outcome of tuberculous meningitis?

Background: Stroke is common in tuberculous meningitis ( TBM), and aspirin has been shown to reduce mortality. A combination of aspirin and corticosteroid may be more useful in this condition. Aim: To evaluate the effect of aspirin and corticosteroid adjunctive therapy alone or in combination in determining the outcome of TBM. Materials and Methods: One hundred and fifty-three patients with TBM were evaluated from a prospectively maintained registry. The diagnosis of TBM was based on the clinical, magnetic resonance imaging ( MRI)/ computed tomography ( CT), and cerebrospinal fluid criteria. The baseline clinical, laboratory, and radiological findings were noted. All patients received the standard 4-drug antituberculous ( rifampicin, isoniazid, pyrazinamide, and ethambutol) treatment. Group I patients received in addition, aspirin, in the dose of 150 mg daily; group II patients received aspirin 150 mg plus prednisolone 40 mg daily; and, group III patients received none of these adjunctive therapies. The outcome at 3 months was defined in terms of death or functional disability. Results: Group I had 44, group II had 50, and group III had 41 patients. The baseline characteristics of all these patients were similar, except in group II, where patients had more severe meningitis and focal deficits compared to the patients in group I and III. At 3 months, 32 ( 23%) patients died; 8 ( 18.2%) in group I, 9 ( 18%) in group II, and 14 ( 34.1%) in group III. There was insignificant survival benefit in group II ( hazard ratio [ HR], 1.55; 95% confidence interval ( CI), 0.96- 26.49; P = 0.07). The three-month functional outcome and side effects were not significantly different in the three groups. Conclusion: Aspirin with corticosteroid adjunctive treatment seems to be beneficial in reducing mortality in TBM.