What is the recommended dosage of Dexona (dexamethasone) in TB meningitis?

Dexamethasone Dosing in TB Meningitis

For adults with TB meningitis, administer dexamethasone 0.4 mg/kg/day (maximum 12 mg/day) intravenously for 3 weeks, then taper gradually over the following 3 weeks for a total of 6 weeks. 1, 2

Adult Dosing Protocol

Initial Phase:

• Start dexamethasone at 0.4 mg/kg/day with a maximum dose of 12 mg/day 1
• Administer intravenously for the first 3 weeks 1
• Begin dexamethasone before or with the first dose of anti-TB medications for maximum mortality benefit 1

Tapering Phase:

• Gradually decrease the dose over weeks 4-6 1, 2
• Total treatment duration is 6 weeks 1, 2

Alternative Prednisolone Regimen:

• If prednisolone is used instead, start at 60 mg/day orally 1
• Taper over 6-8 weeks 3
• One specific tapering schedule: 60 mg/day for 4 weeks, then 30 mg/day for 4 weeks, 15 mg/day for 2 weeks, and 5 mg/day for the final week 1

Pediatric Dosing Protocol

Weight-Based Dosing:

• Children <25 kg: dexamethasone 8 mg/day 1, 2
• Children ≥25 kg: dexamethasone 12 mg/day (same as adults) 1, 2
• Duration: 3 weeks at initial dose, then taper over following 3 weeks 1, 2

Evidence Supporting This Recommendation

The American Thoracic Society/CDC/Infectious Diseases Society of America provides a strong recommendation for adjunctive corticosteroids in TB meningitis based on moderate certainty evidence showing mortality benefit 3, 2. The greatest benefit is seen in Stage II disease (lethargic patients), where mortality decreased from 40% to 15% with dexamethasone treatment 2. Six of eight controlled trials demonstrated benefit in terms of survival or reduced neurological sequelae 2.

Concurrent Anti-TB Therapy

Initial 2-Month Phase:

• Isoniazid (INH), rifampicin (RIF), pyrazinamide (PZA), and ethambutol (EMB) daily 3, 2

Continuation Phase:

• INH and RIF for an additional 7-10 months 3, 1
• Total anti-TB treatment duration: 9-12 months 1

Monitoring Considerations

• Perform repeated lumbar punctures to monitor CSF cell count, glucose, and protein, especially early in therapy 3, 1, 2
• Watch for symptoms of CNS inflammation recurring if steroid taper is too rapid 4
• If symptoms worsen during tapering, slow the taper or temporarily increase the dose 4

Critical Pitfalls to Avoid

Timing Error: Do not delay corticosteroid initiation—it must be given before or with the first anti-TB dose to achieve mortality benefit 1, 2. Starting steroids late reduces effectiveness.

Premature Tapering: Tapering too quickly or too early can cause rebound CNS inflammation 4. Stick to the 6-week protocol with 3 weeks at full dose before beginning taper.

Inadequate Initial Dose: Using lower doses than recommended (0.4 mg/kg/day or 12 mg/day maximum) may not provide adequate anti-inflammatory effect 1.

HIV Considerations: Use corticosteroids with caution in HIV-infected patients with TB meningitis, though they are still recommended 1.