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Tuberculous meningitis: treatment

Alexey Portnov, medical expert
Last reviewed: 19.10.2021

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Treatment of tuberculous meningitis

Various combinations of anti-TB drugs are used. During the first 2 months and before the sensitivity to antibiotics are identified, 4 drugs (the first stage of treatment): isoniazid, rifampicin, pyrazinamide and ethambutol or streptomycin. The scheme is corrected after determining the sensitivity to the drugs. After 2-3 months of treatment (the second stage of treatment) often go to 2 drugs (usually isoniazid and rifampicin). The minimum duration of treatment is usually 6-12 months. Use several combinations of drugs.

Isoniazid 5-10 mg / kg, streptomycin at 0.75-1 g / day in the first 2 months. With constant monitoring of the toxic effect on the VIII pair of cranial nerves, ethambutol is 15-30 mg / kg per day. When using this triad, the severity of intoxication is relatively low, but the bactericidal effect is not always sufficient.
To strengthen the bactericidal effect of isoniazid, together with streptomycin and ethambutol, rifampicin is added at a dose of 600 mg once a day.
In order to maximize the bactericidal effect, pyrazinamide is used at a daily dose of 20-35 mg / kg in combination with isoniazid and rifampicin. However, the combination of these drugs significantly increases the risk of hepatotoxic effects.

The following combination of drugs is also used: paraaminosalicyl acid up to 12 g / day (0.2 g per kg of body weight in divided doses 20-30 minutes after meals, washed with alkaline water), streptomycin and ftivazide in a daily dose of 40-50 mg / kg (0.5 g 3-4 times a day).

In the treatment, the first 60 days of the disease are crucial. In the early stages of the disease (within 1-2 months), it is advisable to use glucocorticoids inside to prevent adhesive pachymeningitis and related complications.

Treatment in the hospital should be long (about 6 months), combined with restorative measures, increased nutrition and the subsequent stay in a specialized sanatorium. Then within a few months the patient continues to take isoniazid. The total duration of treatment is 12-18 months.

For the prevention of neuropathies apply pyridoxine (25-50 mg / day), tioktovuyu acid, multivitamins. It is necessary to monitor patients to prevent drug intoxication in the form of liver damage, peripheral neuropathies, including damage to the optic nerves, as well as prevent complications in the form of cicatricial process and open hydrocephalus.

Forecast

Before the use of anti-TB drugs, meningitis ended with death on the 20th-25th day of the disease. At present, with timely and long-term treatment, a favorable outcome occurs in 90-95% of cases. At a delayed diagnostics (after 18-20 day of illness) the forecast bad. Sometimes there are relapses and complications in the form of epileptic seizures, hydrocephalus, neuro-endocrine disorders.

trusted-source [1], [2], [3], [4], [5], [6], [7], [8]

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