Tuberculous meningitis treated with streptomycin and isoniazid without intrathecal therapy.

Isoniazid given orally readily and rapidly diffuses into the cerebrospinal fluid in health and disease (Fletcher, I952, 1953) and probably, also, gains access to tubercle bacilli within the cells. Adequate bacterio-static level of the isoniazid in the cerebrospinal fluid was found in both lower and higher doses. Throughout the illness Ritchie (I953) showed that isoniazid is more diffusible in the cerebrospinal fluid and has got more rapid action on tubercle bacilli, promoting increased vascularity and resolution of the lesions in the miliary and the meningeal lesions. Recently, favourable clinical results have been reported by the use of oral isoniazid and intramuscular streptomycin without intrathecal administration of streptomycin in the treatment of tuberculous meningitis (Clark, et al., I952; Anderson, et al., I953; Bulkeley, I953; TorresGost, 1953; Mackay, 1954; Kendig, et al., I954; Smellie, 1954; and Robinson and Ro, 1954). The treatment with intrathecal streptomycin in cases of tuberculous meningitis has certain disadvantages: (I) Continued intrathecal streptomycin injections, even in expert hands, give rise to repeated trauma to the spinal theca and consequently meningeal thickening and block. (2) Toxicity of the antibiotic. (3) Long stress on the little patient. (4) Continued interference of the cerebrospinal fluid by introducing a foreign and toxic substance. The oral use of isoniazid and intramuscular streptomycin might eliminate the intrathecal use of streptomycin without sacrificing the antimicrobic activity, within the central nervous system. In I954, few cases were treated with oral isoniazid and intramuscular streptomycin without intrathecal streptomycin, with encouraging results. These cases were followed up for a period of two years.