Rong Li,1,2 Rong Yin,2 Yuanming Li,2 Yaxuan Wei,2 Bin Zhao,2 Chaoming Ge1 

1Department of Neurology, Lanzhou University Second Hospital, Lanzhou, People’s Republic of China; 2Department of Neurology, Gansu Province Central Hospital, Lanzhou, People’s Republic of China

Correspondence: Chaoming Ge, Email 13893285120@163.com

Abstract: Tuberculous meningitis (TBM), a central nervous system infection caused by Mycobacterium tuberculosis, is a rapidly progressing, insidious disease with an exceptionally high disability and mortality rate. Its significant global burden has become a critical focus in public health. The clinical diagnosis of TBM faces challenges due to the lack of specific symptoms and imaging characteristics, making early detection difficult. Combined with the shielding effect of the blood-brain barrier against anti-tuberculosis drugs and the issue of drug resistance, treatment outcomes are often suboptimal. Furthermore, current early sensitive diagnostic tools are inadequate, leading to delayed treatment for many patients and adversely affecting their prognosis. This paper reviews the pathophysiological mechanisms of TBM, the types and mechanisms of action of therapeutic drugs, and the common drug selection issues and safety challenges encountered in clinical practice. The aim is to provide comprehensive guidance and references for clinical diagnosis and treatment to improve the therapeutic outcomes and quality of life for TBM patients.

Keywords: tuberculous meningitis, treatment strategies, drug selection, host-directed therapy, multidrug resistance