SHORT-COURSE THERAPY IN TUBERCULOUS MENINGITIS. A STUDY OF 16 PATIENTS

From 1986-1989, sixteen patients suffering from TB meningitis aged 12-58, with CSF smear or culture positive for Mycobacterium tuberculosis were hospitalized and treated with rifampin (RIF) , isoniazid (INH) , pyrazinamide (PZA) and ethambutol (ETB) for nine months. In all patients, ETB and PZA were withdrawn after three months and INH and RIF were continued for the next six months. 81.2 percent of patients were in stages 2 and 3 of this illness, and steroids were added to their treatment regimes. In two patients whose liver enzymes and blood uric acid levels increased during the second week of therapy, INH was discontinued temporarily and PZA was replaced with streptomycin. In the remaining patients, side effects of drugs and central, peripheral and other complications were trivial. Mortality rate was 25%, follow-up of the patients continued for 12-24 months. According to the mortality and morbidity of classic 12-18 months therapy with three drugs and results obtained in this study, treatment with four drugs for nine months showed some advantages to the other protocols. We look forward to finding more documents and similar studies from other centers. Confirmation of results of this study could be a suggestion for short-course therapy in TB meningitis, and this is the first report of short-course therapy in TB meningitis from Iran.