scholarly journals Pharmacokinetics and Pharmacodynamics of Intensive Antituberculosis Treatment of Tuberculous Meningitis

2020 ◽  
Vol 107 (4) ◽  
pp. 1023-1033 ◽  
Author(s):  
Junjie Ding ◽  
Nguyen Thuy Thuong Thuong ◽  
Toi Van Pham ◽  
Dorothee Heemskerk ◽  
Thomas Pouplin ◽  
...  
Keyword(s):  
Tuberculous Meningitis ◽  
Pharmacokinetics And Pharmacodynamics ◽  
Antituberculosis Treatment

scholarly journals Randomized Pharmacokinetic and Pharmacodynamic Comparison of Fluoroquinolones for Tuberculous Meningitis

2011 ◽  
Vol 55 (7) ◽  
pp. 3244-3253 ◽  
Author(s):  
Guy E. Thwaites ◽  
Sujata M. Bhavnani ◽  
Tran Thi Hong Chau ◽  
Jeffrey P. Hammel ◽  
M. Estée Török ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Tuberculous Meningitis ◽  
Drug Exposure ◽  
Time Curve ◽  
Exposure Response ◽  
Antituberculosis Treatment ◽  
Improved Outcomes ◽  
Days Of Therapy ◽  
Fluid Penetration ◽  
New Treatments

ABSTRACTTuberculous meningitis (TBM) is the most lethal form of tuberculosis, and new treatments that improve outcomes are required. We randomly assigned adults with TBM to treatment with standard antituberculosis treatment alone or in combination with ciprofloxacin (750 mg/12 h), levofloxacin (500 mg/12 h), or gatifloxacin (400 mg/24 h) for the first 60 days of therapy. Fluoroquinolone concentrations were measured with plasma and cerebrospinal fluid (CSF) specimens taken at predetermined, randomly assigned times throughout treatment. We aimed to describe the pharmacokinetics of each fluoroquinolone during TBM treatment and evaluate the relationship between drug exposure and clinical response over 270 days of therapy (Controlled Trials number ISRCTN07062956). Sixty-one patients with TBM were randomly assigned to treatment with no fluoroquinolone (n= 15), ciprofloxacin (n= 16), levofloxacin (n= 15), or gatifloxacin (n= 15). Cerebrospinal fluid penetration, measured by the ratio of the plasma area under the concentration-time curve from 0 to 24 h (AUC0–24) to the cerebrospinal fluid AUC0–24, was greater for levofloxacin (median, 0.74; range, 0.58 to 1.03) than for gatifloxacin (median, 0.48; range, 0.47 to 0.50) or ciprofloxacin (median, 0.26; range, 0.11 to 0.77). Univariable and multivariable analyses of fluoroquinolone exposure against a range of different treatment responses revealed worse outcomes among patients with lower and higher plasma and CSF exposures than for patients with intermediate exposures (a U-shaped exposure-response). TBM patients most likely to benefit from fluoroquinolone therapy were identified, along with exposure-response relationships associated with improved outcomes. Fluoroquinolones add antituberculosis activity to the standard treatment regimen, but to improve outcomes of TBM, they must be started early, before the onset of coma.

scholarly journals Tuberculous Meningitis in The Differential Diagnosis of Cns Infection and the Urgency of Antituberculosis Treatment

2015 ◽  
Vol 1 (1) ◽  
Author(s):  
Sanliay Sahin ◽  
Mutlu U. Yazici ◽  
Ganime Ayar ◽  
Emine Akkuzu ◽  
Aslinur O. Parlakay ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Tuberculous Meningitis ◽  
Cns Infection ◽  
Antituberculosis Treatment

scholarly journals Use of Roche AMPLICOR Mycobacterium tuberculosis PCR in Early Diagnosis of Tuberculous Meningitis

1998 ◽  
Vol 36 (5) ◽  
pp. 1251-1254 ◽  
Author(s):  
Alec Bonington ◽  
J. I. George Strang ◽  
Paul E. Klapper ◽  
Steven V. Hood ◽  
William Rubombora ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Mycobacterium Tuberculosis ◽  
Tuberculous Meningitis ◽  
Laboratory Findings ◽  
Antituberculosis Treatment ◽  
Few Data ◽  
A Prospective Study ◽  
Specific Diagnostic Test ◽  
Pcr Test ◽  
Csf Findings

Several nucleic acid-based amplification tests are available for the detection of Mycobacterium tuberculosis, but few data are available on their use in the diagnosis of tuberculous meningitis (TBM). We performed a prospective study to assess the Roche AMPLICORMycobacterium tuberculosis PCR test (TB AMPLICOR) for use in the diagnosis of TBM and compared it with direct Ziehl-Neelsen staining of smears, radiometric culture for M. tuberculosis, and clinical and cerebrospinal fluid (CSF) findings. Eighty-three CSF specimens collected from 69 patients with suspected meningitis in South Africa were tested by TB AMPLICOR. On the basis of clinical and laboratory findings, 40 of these patients were treated for TBM and 29 patients were not treated for TBM. Ten CSF samples from 10 patients were positive by TB AMPLICOR. Seven of these 10 patients were classified as having definite TBM, 2 were classified as having probable TBM, and 1 was classified as having possible TBM. The sensitivity of TB AMPLICOR for detecting cases of definite and probable TBM in patients from whom CSF specimens had been collected less than 10 days into antituberculosis treatment was 60.0%. Specimens from all 29 patients not treated for TBM were negative by the TB AMPLICOR, giving a 100% specificity. TB AMPLICOR is therefore more sensitive than the combination of Ziehl-Neelsen staining of smears and radiometric culture for M. tuberculosis and is a rapid and highly specific diagnostic test for TBM.

scholarly journals Clinical Outcome of Tuberculous Meningitis with Hydrocephalus — A Retrospective Study

2021 ◽  
Vol 28 (5) ◽  
pp. 82-93
Author(s):  
Davendran Kanesen ◽  
◽  
Regunath Kandasamy ◽  
Albert Wong Sii Hieng ◽  
John Tharakan ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Clinical Outcome ◽  
Cell Count ◽  
Tuberculous Meningitis ◽  
Surgical Intervention ◽  
Cox Regression ◽  
Survival Function ◽  
Adequate Treatment ◽  
Poor Outcome ◽  
Antituberculosis Treatment

Background: To study the clinical outcome of tuberculous meningitis with hydrocephalus (TBMH) and the factors contributing to its poor clinical outcome. Methods: Clinical data of 143 adult patients diagnosed with TBM over a 6-year period in two tertiary hospitals in Malaysia were retrospectively reviewed. Relevant clinical and radiological data were studied. Patients with TBMH were further analysed based on their clinical grade and rendered treatment to identify associated factors and outcome of this subgroup of patients. The functional outcome of patients was assessed at 12 months from treatment. Results: The mean age of patients was 35.6 (12.4) years old, with a male gender predominance of 67.1%. Forty-four percent had TBMH, of which 42.9% had surgical intervention. In the good modified Vellore grade, 76.5% was managed medically with concurrent antituberculosis treatment (ATT), steroids and osmotic agents. Four patients had surgery early in the disease as they did not respond to medical therapy and reported a good outcome subsequently. Poor outcome (65.2%) was seen in the poor modified Vellore grade despite medical and surgical intervention. Multivariate model multiple Cox regression showed significant results for seizure (adjusted hazard ratio [aHR]: 15.05; 95% CI: 3.73, 60.78), Glasgow coma scale (GCS) (aHR: 0.79; 95% CI: 0.70, 0.89) and cerebrospinal fluid (CSF) cell count (aHR: 1.11; 95% CI: 1.05, 1.17). Conclusion: Hydrocephalus was seen in 44% of patients in this study. GCS score, seizure and high CSF cell count were factors associated with a poor prognosis in TBM. Patients with TBMH treated medically (TBMHM) had better survival function compared to TBMH patients undergoing surgical intervention (TBMHS) (P-value < 0.001). This retrospective study emphasises that TBMH is still a serious illness as 47.6% of the patients had poor outcome despite adequate treatment.

Pharmacokinetics and pharmacodynamics of meperidine in healthy horses

2020 ◽  
Vol 47 (6) ◽  
pp. 855.e11-855.e12
Author(s):  
H. Trenholme ◽  
A. Hanafi ◽  
R. Reed ◽  
D. Sakai ◽  
C. Ryan ◽  
...  
Keyword(s):  
Pharmacokinetics And Pharmacodynamics

CT OF THE BRAIN IN TUBERCULOUS MENINGITIS: A review of 289 patients

2000 ◽  
Vol 41 (1) ◽  
pp. 13-17
Author(s):  
M. Özateş ◽  
S. Kemalogˇlu ◽  
F. Gürkan ◽  
Özkan Ü. ◽  
Not Available Not Available ◽  
...  
Keyword(s):  
Tuberculous Meningitis ◽  
The Brain

Neuroborreliosis as a chameleon - mimicking tuberculous meningitis

2012 ◽  
Vol 43 (02) ◽  
Author(s):  
J Merfort ◽  
T Linden ◽  
B Fiedler ◽  
W Schwindt ◽  
H Omran ◽  
...  
Keyword(s):  
Tuberculous Meningitis
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