The intracellular location of the bacteria may pose problems in the treatment of brucellosis. The optimal regimen is not uniformly accepted. Adequate CSF levels may not be achieved for tetracycline and aminoglycosides. The recommended dose of doxycycline accepted by most authorities is 100 mg orally twice a day combined with two or more other drugs (rifampin 600–900 mg orally once a day/streptomycin 1 g intramuscular once a day) and treatment has to be continued for a few weeks as per the response of the patient. Doxycycline crosses the blood-brain barrier better than generic tetracycline, and with trimethoprim-sulfamethoxazole and rifampin, better and more successful response has been seen for Brucella meningitis. Other drugs like 3rd-generation cephalosporins have high penetration to CSF but sensitivity and response of Brucella spp. is variable, and in vitro sensitivity should be ensured before using it. Antibiotic treatment has to be given for 1–19 months and CSF should be cleared. Steroids are to be used and are recommended for neurobrucellosis treatment, but the efficacy has not been proved in the absence of controlled studies. All patients are to be kept under review for 1 year after the completion of antibiotic treatment and the serum agglutinins has to fall to normal levels [1].

In cases of neurobrucellosis, the CNs usually remain affected permanently to some extent. Treatment usually does not cure the damage to the CNs, although little improvement may be seen after completion of treatment; however, in a few cases, complete resolution has been reported where diagnosis was made early and treatment was started early. This complete resolution has been reported in cases with involvement of CN VIII or VI and even in involvement of other CNs [14].