Related Experiment Video

Updated: May 29, 2026

A High-throughput Compatible Assay to Evaluate Drug Efficacy against Macrophage Passaged Mycobacterium tuberculosis
10:29

A High-throughput Compatible Assay to Evaluate Drug Efficacy against Macrophage Passaged Mycobacterium tuberculosis

Published on: March 24, 2017

Efficacy and Safety of High-Dose Rifampicin in the Management of Tuberculosis Meningitis: A Systematic Review and

Syed Saad Ali1, Wifag Medani Malik2, Sandhya Narahari3

  • 1Neurology, Pakistan Institute of Medical Sciences, Islamabad, PAK.

Cureus
|May 28, 2026
PubMed

Insights

High-dose rifampicin increases drug exposure for tuberculosis meningitis (TB) treatment but does not reduce mortality. This approach elevates neurological adverse event risks, necessitating further research for optimal dosing strategies.

Area of Science:

  • Infectious Diseases
  • Pharmacology
  • Neurology

Background:

  • Tuberculosis meningitis (TBM) is a severe form of TB with high mortality and neurological sequelae.
  • Standard rifampicin doses may not reach therapeutic levels in the central nervous system for TBM.
  • High-dose rifampicin is explored to improve drug exposure and clinical outcomes in TBM.

Purpose of the Study:

  • To systematically review and meta-analyze the effectiveness and safety of high-dose versus standard-dose rifampicin for TBM treatment.
  • To evaluate the impact of high-dose rifampicin on drug pharmacokinetics and patient mortality.
  • To assess the safety profile, including neurological adverse events, associated with high-dose rifampicin in TBM.

Main Methods:

  • Systematic review and meta-analysis of randomized controlled trials (RCTs) published between 2010 and 2026.
  • Searched PubMed, Cochrane Library, and ScienceDirect for relevant RCTs involving adult TBM patients.
  • Used random-effects models to pool pharmacokinetic data (Cmax, AUC(0-24)) and mortality risk ratios (RR).

Main Results:

  • High-dose rifampicin significantly increased maximum plasma concentration (Cmax) and total drug exposure (AUC(0-24)) compared to standard doses.
  • No significant difference in six-month mortality was observed between high-dose and standard-dose rifampicin groups.
  • The risk of neurological adverse events was significantly higher in the high-dose rifampicin group, while other adverse events were comparable.

Conclusions:

  • High-dose rifampicin enhances pharmacokinetic exposure in TBM patients.
  • Current evidence does not support a reduction in mortality with high-dose rifampicin for TBM.
  • The increased risk of neurological adverse events with high-dose rifampicin warrants caution and further investigation.
Keywords:
high-dose therapypharmacokineticsrandomised controlled trialsrifampicintuberculosis meningitis

More Related Videos

System for Efficacy and Cytotoxicity Screening of Inhibitors Targeting Intracellular Mycobacterium tuberculosis09:57

System for Efficacy and Cytotoxicity Screening of Inhibitors Targeting Intracellular Mycobacterium tuberculosis

Published on: April 5, 2017

Related Concept Videos

Pulmonary Tuberculosis V01:28

Pulmonary Tuberculosis V

Medical management of tuberculosis (TB) patients involves a comprehensive approach that includes diagnosis, treatment, and monitoring. The specific strategies can vary depending on the type of tuberculosis (latent or active), the patient's overall health status, and other considerations.
Latent tuberculosis infection occurs when TB bacteria are present in a person's body, but are not causing illness or symptoms. It is not contagious, and preventive treatment is crucial to avoid the progression...
Pulmonary Tuberculosis IV01:26

Pulmonary Tuberculosis IV

Tuberculosis, more commonly referred to as TB, is an infectious disease stemming from Mycobacterium tuberculosis. While it primarily impacts the lungs, TB can also affect other body areas. Given its severity and global impact, timely and accurate diagnosis is crucial for controlling its spread and improving patient outcomes.
Several diagnostic approaches are used to detect TB. The conventional method is the Tuberculin Skin Test (TST), also known as the Mantoux test. However, this method has...
Cryptococcal Meningitis01:27

Cryptococcal Meningitis

Cryptococcal meningitis is a life-threatening opportunistic infection predominantly associated with HIV/AIDS, accounting for over 100,000 deaths annually worldwide. However, it also affects individuals with other forms of immunosuppression, including those undergoing immunosuppressive therapy, organ transplant recipients, patients with innate immunodeficiencies, and individuals with hematological disorders. The infection is caused mainly by Cryptococcus neoformans and Cryptococcus gattii,...
Mechanism of Antibiotic Resistance in MRSA01:25

Mechanism of Antibiotic Resistance in MRSA

Antibiotic resistance in bacteria arises when microorganisms evolve the ability to withstand drugs designed to kill them or inhibit their growth, rendering once-effective treatments useless. This phenomenon, driven by genetic change and selection under antibiotic exposure, poses a profound threat to modern medicine. Mechanisms include drug-inactivating enzymes (e.g., β-lactamases), efflux pumps that eject antibiotics, mutations altering antibiotic targets, decreased drug uptake, and acquisition...
Pulmonary Tuberculosis I01:29

Pulmonary Tuberculosis I

Tuberculosis, often called TB, is a contagious illness primarily caused by Mycobacterium tuberculosis. It mainly affects the lung parenchyma but can also impact other body parts.
Causative Organism
The primary infectious agent causing tuberculosis is Mycobacterium tuberculosis, a slow-growing, acid-fast, aerobic rod that exhibits sensitivity to heat and ultraviolet light. Instances of Mycobacterium bovis and Mycobacterium avium contributing to the development of TB infection are rare.
Mode of...
Bacterial Meningitis I: Introduction01:22

Bacterial Meningitis I: Introduction

Bacterial meningitis is a severe, life-threatening inflammation of the meninges, particularly the pia mater and arachnoid mater, affecting the subarachnoid space, ventricles, and cerebrospinal fluid (CSF). If untreated, it can lead to significant neurological complications or death.Causative AgentsCommon pathogens vary with age and immune status. In adults, major organisms include Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae. Streptococcus agalactiae (group B...