Recent clinical management of subacute meningitis is reviewed. Tuberculous meningitis (TbM) and fungal meningitis are the commonest cause of subacute meningitis. Since the delayed treatment in these meningitides is strongly associated with poor outcome, these clinical managements are required to be neurological emergency. Recent clinical guidelines of these meningitides recommended new therapeutic managements.
Treatment for TbM should consist of 4 drugs (isoniazid, rifampicin, pyrazinamide, ethambutol) for 2 months followed by 2 drugs (isoniazid, rifampicin) for at least 10 months. Adjunctive corticosteroids should be given to all non-HIV patients with TbM, regardless of disease severity.
Treatment for CNS Cryptococcosis and Candidiasis with non-HIV infected and non-transplant hosts is lipid formulation of Amphotericin B combined with flucytosine for at least 4 weeks for induction therapy. This 4-week induction therapy is reserved for patients with meningoencephalitis without neurological complications and CSF yeast culture results that are negative after 2 weeks of treatment. Then, the consolidation with fluconazole for 8 weeks is started. Voriconazole is recommended for the primary treatment of CNS Aspergillosis including meningitis.
If the diagnosis is made early, if clinicians adhere to the basic principles of these guidelines, and if the underlying disease is controlled, these meningitides could be managed successfully in the most of patients.