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Tuberculous Meningitis

Прочитайте:
  1. Aseptic meningitis
  2. Bacterial and viral meningitis
  3. Chronic meningitis
  4. Chronic meningitis
  5. Epidemiology of aseptic meningitis
  6. Epidemiology of bacterial meningitis
  7. Fungal Meningitis (AIDS-Related Cryptococcal Meningitis)
  8. Fungal meningitis update
  9. Meningitis caused by Neisseria meningitides
  10. Meningitis overview

Depending on the resistance pattern in the community and the results of susceptibility testing (once available), always treat tuberculous meningitis with a combination of drugs. Isoniazid (INH) and pyrazinamide (PZA) attain good CSF levels (approximate blood levels). Rifampin (RIF) penetrates the blood-brain barrier less efficiently but still attains adequate CSF levels.

The use of a combination of the first-line drugs (ie, INH, RIF, PZA, ethambutol, streptomycin) is advocated. The dosage is similar to what is used for pulmonary tuberculosis (ie, INH 300 mg qd, RIF 600 mg qd, PZA 15-30 mg/kg qd, ethambutol 15-25 mg/kg qd, streptomycin 7.5 mg/kg q12h).

Evidence regarding the appropriate duration of treatment is conflicting. A treatment duration of 12 months is the minimum, and some experts suggest a duration of at least 2 years.

The use of corticosteroids is indicated for individuals with stage 2 or stage 3 disease (ie, patients with evidence of neurologic deficits or changes in their mental function). The recommended dose is 60-80 mg/d, which may be tapered gradually during a span of 6 weeks. The rationale lies in the reduction of inflammatory effects associated with mycobacterial killing by the antimicrobial agents.

Go to Tuberculous Meningitis for complete information on this topic.

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