Does High-Dose Rifampin Improve Tuberculous Meningitis Outcomes?

Tuberculous meningitis is associated with high morbidity and mortality. Would increasing the central nervous system levels of the key drug rifampin improve outcomes? A large clinical trial showed no clinical benefit of increasing the dose from the standard 10 mg/kg/day to 15 mg/kg/day. Now, investigators evaluated the impact on 6-month mortality of 35 mg/kg/day of rifampin versus the standard dose in the first 8 weeks of treatment in a double-blinded, randomized, multinational study. Five hundred patients (median age, 37) with confirmed or suspected tuberculous meningitis were enrolled.