The study evaluates Increased-dose Rifampicin, additional Levofloxacin, and combination efficacy in treating Tuberculous meningitis (TBM).

TBM poses challenges, especially in high Tuberculous (TB) and HIV regions, with persistently high mortality and morbidity rates despite treatment advancements. The complexity of TBM and HIV therapies could provoke potential interactions, highlighting the urgent need to systematically assess the effectiveness of adjuvant Rifampicin, Levofloxacin, and their combination.

This review analyzed data from 9 databases (Scopus, PubMed, Cochrane, Sage Pub, ProQuest, PLOS, EBSCO, Epistemonikos, and Springer) using predefined keywords. It focused on TBM with and without HIV, comparing the efficacy of increased-dose Rifampicin, additional Levofloxacin, and combination towards standard therapy. Quality assessment utilized the Risk of Bias version 2 (RoB v2) measure. Meta-analysis was conducted using Review Manager 5.4.

Seven studies, encompassing 1647 participants, were analyzed comparing additional Levofloxacin and increased-dose Rifampicin towards standard therapy exhibited non-significant overall effects on adverse events, with pooled odds ratios (ORs) of 1.19 (95% CI 0.91 to 1.56; P=0.20) and 1.30 (95% CI 0.37 to 4.62; P=0.68) respectively. Furthermore, the assessment of mortality rates showed non-significant results, with pooled hazard ratios (HRs) of 0.85 (95% CI, 0.66 to 1.10; P=0.21) for additional Levofloxacin and 0.65 (95% CI, 0.30 to 1.39; P=0.27) for increased-dose Rifampicin, compared to standard therapy.

Increased-dose Rifampicin and additional Levofloxacin may not be necessary for treating TBM meningitis, evidenced by the variable efficacy observed across different treatment groups and outcomes. However, further research is required to effectively guide clinical practice.