Three chemotherapy studies of tuberculous meningitis in children

Chemotherapy studies were undertaken in 180 patients with tuberculous meningitis. They were treated for 12 months withlof3 regimens: the first consisted of streptomycin, isoniazid and rifampicin daily for the first 2 months, followed by ethambutol plus isoniazid for 10 months; in the second, pyrazinamide was added for the first 2 months, and in the third, rifampicin was re-duced to twice weekly in the first 2 months. In the first regimen alone, streptomycin was also given twice weekly from the third to the sixth month. Steroids were prescribed for all the patients in thc initial weeks of treatment. Approximately 50% of the patients were aged less than 3 years. On admission, 13%of the patients were classified as stage 1,77% as stage Hand 9% as stage III. Cere-brospinal fluid (CSF) culture results were available for all the 180 patients and M. tuberculosis was isolated in 59 (33%). CSF smear results for acid fast bacilli were available only for the 103 patients admitted to the second and the third studies, and of these, in 60 (58%) the CSF was positive cither by smear or culture. The response to therapy was similar in the 3 studies. Despite administration of rifampicin for 2 months, the mortality was high. In all, 27% of the patients died of tuberculous meningitis, 39% had neurological sequelae and 34% recovered completely. There was a strong association between ilu stage on admission and the mortality rate, the deaths being highest in stage III. In the first study; when isoniazid was prescribed daily in a dosage of 20 mg/kg, 39 % of the patients developed jaundice however, when the dosage was reduced to 12 mg/kg, the incidence was only 16%. In the third study. where rifampicin was administered twice a week, the incidence of jaundice was low (5%)