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Tuberculous meningitis: is a 6-month treatment regimen sufficient?
J H van Loenhout-Rooyackers1, A Keyser, R J Laheij
1Public Health Office (GGD), Nijmegen, The Netherlands. jloenhout@GGD-Nijmegen.nl
Setting:
The British Thoracic Society and the American Thoracic Society advise 12 months treatment for tuberculous meningitis, with at least isoniazid (H), rifampicin (R) and pyrazinamide (Z).
Objective:
To establish whether a 6-month treatment regimen for tuberculous meningitis is equally as effective as longer treatment.
Method:
Medline search for papers published between 1978 and 1999.
Inclusion Criteria:
study populations of patients with tuberculous meningitis in whom the diagnosis was confirmed with clinical, cerebrospinal fluid and epidemiological findings; a treatment regimen with at least HRZ and at least 12 months of follow-up after the completion of treatment.
Outcome Measure:
the number of relapses.
Results:
There were four 6-month treatment regimens (G6) and seven longer treatment regimens (G>6); 160/197 (81%) patients completed the 6-month treatment regimens, while 577/675 (85%) completed the longer-term regimens. The clinical stage of patients in the G6 group was poorer than in the G>6 group. Relapse occurred in two out of 131 (1.5%) G6 and in 0 out of 591 G>6 patients.
Conclusion:
Although no studies have compared 6-month treatment regimens with longer treatment, it can be concluded on the basis of this literature review that 6-month treatment is sufficient for tuberculous meningitis with fully susceptible mycobacteria.
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