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Short Intensified Treatment in Children with Drug-susceptible Tuberculous Meningitis

van Toorn, Ronald FCP*; Schaaf, H. Simon MD*; Laubscher, Jacoba A. BCOMM; van Elsland, Sabine L. MSc*‡; Donald, Peter R. MD*; Schoeman, Johan F. MD*

Pediatric Infectious Disease Journal: March 2014 - Volume 33 - Issue 3 - p 248–252
doi: 10.1097/INF.0000000000000065
Original Studies

Background: The World Health Organization recommends 12-month treatment (2RHZE/10RH) for children with tuberculous meningitis (TBM). Studies evaluating length of antituberculous treatment for TBM report similar completion and relapse rates comparing 6-month treatment with 12-month treatment.

Methods: A prospective evaluation to determine whether short-course intensified treatment (6 RHZEth for HIV-infected and 9RHZEth for HIV-infected) is sufficient and safe in children with drug-susceptible TBM.

Results: Of 184 children with TBM, median age 58 months and 90 (49%) male, 98 children (53%) presented at stage II TBM, 64 (35%) at stage III TBM and only 22 (12%) at stage I TBM. Ninety (49%) children were treated at home after the first month of therapy; all others received their full treatment in hospital. The HIV prevalence was 14% (22/155 children tested). Anti-TB drug-induced hepatotoxicity occurred in 5% (8 of 143 children tested), all tested negative for viral hepatitis; in all 8 cases, the original regimen was restarted without recurrence. After treatment completion, 147 (80%) children had a good outcome, 7 (3.8%) died. There was no difference in outcome between HIV-infected and HIV-uninfected children who completed treatment (P = 0.986) nor between TBM-hydrocephalic children who were medically treated or shunted (P = 0.166).

Conclusion: Short intensified treatment is safe and effective in both HIV-infected and HIV-uninfected children with drug-susceptible TBM.

From the *Department of Pediatrics and Child Health, Stellenbosch University and Tygerberg Children’s Hospital, Western Cape; Biostatistics Unit, Medical Research Council of South Africa, Tygerberg, Cape Town, South Africa; and Department of Pediatric Infectious Diseases and Immunology, VU University Medical Center, Amsterdam, The Netherlands.

Accepted for publication August 23, 2013.

The authors have no funding or conflicts of interest to disclose.

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Address for correspondence: Ronald van Toorn, Department of Pediatrics and Child Health, Stellenbosch University, PO Box 19063, Tygerberg, 7505, South Africa. E-mail: vtoorn@sun.ac.za.

© 2014 by Lippincott Williams & Wilkins, Inc.