Open AccessClinical outcomes among patients with tuberculous meningitis receiving intensified treatment regimens
Author(s) -
Alison G.C. Smith,
Mariam Gujabidze,
Teona Avaliani,
Henry M. Blumberg,
Jeffrey M. Collins,
Sh. Sabanadze,
Tinatin Bakuradze,
Zaza Avaliani,
Russell R. Kempker,
Maia Kipiani
Publication year - 2021
Publication title -
the international journal of tuberculosis and lung disease/the international journal of tuberculosis and lung disease. articles traduits en français ...
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.103
H-Index - 110
eISSN - 1815-7920
pISSN - 1027-3719
DOI - 10.5588/ijtld.21.0159
Subject(s) - medicine , tuberculous meningitis , regimen , linezolid , surgery , cohort , tuberculosis , prospective cohort study , meningitis , pathology , vancomycin , biology , bacteria , genetics , staphylococcus aureus
SETTING: National Center for Tuberculosis and Lung Diseases (NCTLD), Tbilisi, Georgia. OBJECTIVE: To determine clinical outcomes of patients with tuberculous meningitis (TBM) treated with an intensified regimen including a fluoroquinolone (FQ) and an injectable agent. DESIGN: Prospective cohort of patients aged ≥16 years initiating treatment for TBM at the NCTLD from January 2018 to December 2019. Treatment outcomes and neurologic disability at 1, 6 and 12 months after treatment initiation were assessed. RESULTS: Among 77 patients with median follow-up time of 363 days (IQR 269-374), 97% received a FQ, 62% an injectable agent, 44% linezolid and 39% a carbapenem. Fifty-seven patients (74%) successfully completed treatment, 2 (2.6%) had treatment failure, 6 (7.8%) died, and the remainder (12%) were lost to follow up. Among 11 patients treated for multidrug-resistant TBM, the median follow-up time was 467 days and one patient (8%) died. Regarding neurologic outcomes, 14/76 (18%) patients had Modified Rankin Scores of 0 at baseline, improving to 85% (56/66) and 94% (47/50) at 6 and 12 months, respectively. CONCLUSION: Intensified multidrug treatment regimens including a FQ and an injectable agent in all patients and newly implemented drugs in patients with multidrug-resistant TBM resulted in low mortality and favorable neurologic outcomes.