- Infection usually comes from an adult, so look to caretaker for antimicrobial sensitivity: Since tuberculous meningitis in children is almost always acquired from adults with pulmonary tuberculosis, sensitivities of the infecting organism may be available at diagnosis.
- Isoniazid, rifampin, pyrazinamide, and streptomycin are preferred: In most cases, preferred therapy is to begin isoniazid, rifampin, pyrazinamide, and streptomycin, which all have good CSF penetration, for two months, followed by 10 months of isoniazid and rifampin for susceptible strains. Infectious disease consultation and local health department involvement are essential.
- Look for risk for multi-drug-resistant strain: Multi-drug-resistant tuberculosis should be considered if there is a history of contact with a person with multi-drug-resistant pulmonary tuberculosis or an inadequate clinical response to adequate therapy.
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