Short course chemotherapy study in tuberculous meningitis in children

A total of 215 patients with tuberculous meningitis were treated for nine months with one of the following two regimens: The first regimen consisted of 5 drugs namely Streptomycin, Isoniazid and Ethambutol given daily, supplemented with Rifampicin and Pyrazinamide thrice a week for the first two months, followed by Rifampicin and Isoniazid twice a week for the next seven months. Regimen II was similar to Regimen I excepting that Rifampicin and Pyrazinamide were given twice a week during the first two months of intensive phase, instead of thrice a week. As a general policy, steroids were administered to all the patients for a period of 6 to 8 weeks. On admission, 56% of the patients were aged less than 2 years and 75% less than five years. Forty-five patients (21%) were classified as stage I, 160 (74%) as stage II and only 10 (5%) as stage III. Cerebrospinal fluid culture was positive for tubercle bacilli either by smear, culture or both in 47%. Smear was negative and culture alone was positive in 74 patients and in 14 patients both smear and culture were positive. Of the 88 culture positive patients, in 7 (8%) the cultures were resistant to Streptomycin alone, in 12 (14%) to INH alone, in 11 (12%) to both Streptomycin and INH, while in 2 (2%) patients, they were resistant to all the three drugs. The response to therapy was similar in both the regimens. The mortality was very high, namely 31%, despite using intensive regimens. There was a strong association between the stage on admission and the mortality rate, the latter being highest in stages II and III. This emphasises the need for early diagnosis and treatment in tuberculous meningitis