Intensive short course chemotherapy in the management of tuberculous meningitis
Date
1998
Authors
Donald P.R.
Schoeman J.F.
Van Zyl L.E.
De Villiers J.N.
Pretorius M.
Springer P.
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Abstract
SETTING: Short course chemotherapy for tuberculous meningitis (TBM) is advocated by several groups, but relatively few children have been so treated and followed up. METHODS: A prospective, observational study of isoniazid (INH), rifampicin (RMP) and ethionamide (ETH) in a dosage of 20 mg/kg, and pyrazinamide (PZA) 40 mg/kg, all given once daily in hospital for 6 months. Surviving children were followed up for a year after discharge. RESULTS: Ninety five children, 39 (41%) at stage III, 52 (55%) at stage II and 4 (4%) at stage I TBM were studied. Ten (26%) at stage III and 3 (6%) at stage II died before completion of therapy. Five surviving children (6%) moved on discharge and were untraceable; seven children (9%) were lost during follow up and three were inadvertently restarted on antituberculosis therapy. Two children with severe stage III disease died after discharge. One child experienced a probable disease recrudescence I month after discharge. Eighteen children (20%) developed a mildly elevated serum bilirubin concentration during the first month of treatment. In five of these children INH, RMP, ETH and PZA were stopped and streptomycin (SM) and ethambutol substituted. In all cases the original treatment was restarted without incident. One child developed overt jaundice after 5 months of treatment due to hepatitis A infection. CONCLUSIONS: Our experience suggests that young children with TBM can be safely treated for 6 months with high doses of antituberculosis agents without overt hepatotoxicity and with a low risk of relapse.
Description
Keywords
ethambutol, isoniazid, pyrazinamide, rifampicin, streptomycin, article, bilirubin blood level, child, disease severity, follow up, hepatitis a, human, infection risk, major clinical study, mycobacterium tuberculosis, patient compliance, priority journal, prospective study, treatment planning, tuberculous meningitis, Antibiotics, Antitubercular, Antitubercular Agents, Child, Child, Preschool, Drug Therapy, Combination, Ethionamide, Humans, Infant, Isoniazid, Prospective Studies, Pyrazinamide, Rifampin, Treatment Outcome, Tuberculosis, Meningeal
Citation
International Journal of Tuberculosis and Lung Disease
2
9
2
9