Does Intensified Treatment for Tuberculous Meningitis Improve Survival?

Starting standard 9-month treatment with 8 weeks of adjunctive higher-dose rifampin plus levofloxacin did not reduce mortality.

Tuberculous meningitis still disables or kills almost half of infected patients. At two tertiary referral hospitals in Vietnam, investigators randomly assigned 817 adult inpatients (69% men; median age, 35) with tuberculous meningitis (50% definite, 26% probable, 21% possible) to one of two regimens:

Standard 9-month treatment: isoniazid, rifampin at 10 mg/kg/day, pyrazinamide, and ethambutol for 3 months, then only isoniazid and rifampin for the next 6 months
Intensified treatment: standard treatment plus higher-dose rifampin (15 mg/kg/day) and levofloxacin (20 mg/kg/day) for the first 8 weeks, then only the standard treatment

All participants received dexamethasone for the first 6 to 8 weeks. HIV-infected patients (43% of participants) recei…

Reviewing Author

Mary E. Wilson, MD

Disclosures

Consultant/Advisory BoardOneHealthTrust (formerly Center for Disease Dynamics, Economics, and Policy); Global Health Institute, University of Wisconsin

RoyaltiesUpToDate

Editorial BoardsJournal of Travel Medicine

Mary E. Wilson, MD

Disclosures

Consultant/Advisory BoardOneHealthTrust (formerly Center for Disease Dynamics, Economics, and Policy); Global Health Institute, University of Wisconsin

RoyaltiesUpToDate

Editorial BoardsJournal of Travel Medicine

Does Intensified Treatment for Tuberculous Meningitis Improve Survival?

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Reviewing Author