Short-course chemotherapy for tuberculous meningitis

Abstract

A favourable outcome from the nine-month course of chemotherapy of tuberculous meningitis has been confirmed in 26 out of 28 patients who remained well with no recurrence 12 to 60 months after completing treatment. Two patients died in a vegetative state from other causes seven and nine months after the start of treatment. A further 20 patients were treated similarly with pyrazinamide, isoniazid, rifampicin and streptomycin daily during the first two months, but followed by isoniazid, rifampicin and pyrazinimide for four months with intensive management of the complications during the active stage of the meningitis. Seventeen patients completed the course of treatment and made full recovery with no recurrence three to 38 months later. Three patients developed tuberculomas while on treatment which included corticosteroid and were maintained on antituberculosis drugs for more than one year until the complication cleared up. It is concluded that intensive chemotherapy of tuberculous meningitis in a majority of patients can shorten the duration of treatment to six months with a favourable outcome and that adjunctive corticosteroid administration may be a contributory factor in the development to tuberculoma during antituberculosis treatment.