Background: Pediatric tuberculous meningitis (TBM) in children frequently results in death or permanent impairment. High-dose rifampicin may lower mortality in adults, however role of fluoroquinolones in combination with rifampicin is yet unknown. Objective: To evaluate the effect of combination of effects of levofloxacin and rifampicin in the management of TBM in children and compare the efficacy against standard of care. Methods: Pediatric patients with TBM were enrolled for the study after parental interviews and clinical assessment. Children were randomized to receive high-dose rifampicin and ethambutol (R30HZE, Arm 1), high-dose rifampicin and levofloxacin (R30HZL, Arm 2) or standard-of-care treatment according to the World Health Organization recommendations (HR15ZE, Arm 3). Modified Rankin Scale (MRS) and other neurological test were performed to assess the efficacy of treatment along with safety profile. Results: 25 children were enrolled for the study with a median age of 7.2 years. Stage I, II, and III illness was present in 24%, 32%, and 24% of cases, respectively and of them, 13 (52%) had definite TBM. In arms 1-3, the median (range) MRS scores at admission were 3 (1–4), 2 (1–4), and 2 (1–5), respectively. By week 8, all arms had shown rapid progress, and by week 24, nearly all of the kids had recovered to a score of 0 or 1, which indicates little to no handicap. After correcting for age and baseline MRS, children receiving high-dose rifampicin (arm 1) in neurocognitive tests showed statistically significant improvements in their longitudinal scores for fine motor, receptive language, and expressive language when compared to SOC. Conclusion: The functional results of a pediatric TBM study were quite good. It will need a bigger trial to validate the pattern that child receiving high-dose rifampicin had better neurocognitive results but a higher number of adverse events.