Given that the newer generation fluoroquinolones (FQN), for example, levofloxacin and moxifloxacin, have strong activity against most strains of M. tuberculosis and have excellent CSF penetration and safety profiles, FQN would appear to have great potential as part of first-line therapy for TBM. In a randomized controlled study for TBM treatment, addition of an FQN to standard regimen enhanced anti-TB performance as measured by various clinical parameters. Although there was no significant difference in mortality, the study was likely not adequately powered to demonstrate such an effect [ 38 ]. It is important to note that serum FQN concentrations are lowered by concurrent RIF use; furthermore, the optimal area-under-the-curve to minimum inhibitory concentration ratio for FQN as anti-TB agents has not been well described. Another randomized controlled study is currently underway to evaluate treatment of TBM with high-dose RIF and levofloxacin compared to standard treatment [ 42 ]; if they have positive results, the recommended standard treatment may change in the near future.