SESSION TYPE: TB and NTM
PRESENTED ON: Sunday, October 21, 2012 at 01:15 PM - 02:45 PM
PURPOSE: Tuberculous meningitis (TBM) kills or disables more than half of those affected with disease. Studies have shown that intermittent thrice weekly antituberculous therapy (ATT) is as effective as daily treatment. Directly Observed Treatment Short Course (DOTS) has been widely proposed by the World Health Organization (WHO) as the best way to treat tuberculosis. Whether thrice weekly therapy is as effective as daily therapy in patients with central nervous system (CNS) tuberculosis, especially TBM, is not known. Our aim was to compare the effect of thrice weekly ATT as used in the DOTS regimen with daily ATT in patients with TBM.
METHODS: Subjects within ages 12-75 years, with a diagnosis of TBM who were ATT-naive were enrolled in the study. Subjects with human immunodeficiency virus (HIV) infection, and pregnant women were excluded from the study. Out of 98 subjects assessed for eligibility, 71 subjects met the criteria, and were randomized to receive thrice weekly (36) versus daily (35) ATT. Both groups were followed-up for 9 months with 11 visits. Clinical features, Medical Research Council (MRC) scale for muscle strength, Rankin functional assessment scale, and complications of ATT were recorded at each visit. The primary endpoint of the study was Rankin functional scale score at 9 months. Five subjects were excluded from final analysis as they had not completed 9 months of follow-up.
RESULTS: Baseline characteristics of both the groups [35 in daily group and 36 intermittent group] were similar, except for higher percentage of seizures in the daily group. Patients in the daily ATT group had lower Rankin functional scale score (p = 0.037), lower Medical Research Council scale for muscle strength (p = 0.007), and lower incidence of new onset hydrocephalus (p = 0.03) at the end of 9 months compared to patients in the intermittent ATT group. There was no increase in ATT-related treatment complications in the daily group when compared to the intermittent group.
CONCLUSIONS: Daily therapy with antituberculous agents via DOTS strategy decreases the morbidity, and complications of disease in patients with TBM when compared to thrice weekly therapy.
CLINICAL IMPLICATIONS: Patients with TBM if treated with daily ATT have better outcomes as compared to thrice weekly group, without any mortality benefit. A larger randomized controlled trial is needed to support our hypothesis..
DISCLOSURE: The following authors have nothing to disclose: Nayan Desai, Nagesh Waghmare, Dilip Karnad
No Product/Research Disclosure InformationKing Edward Memorial Hospital and Seth G. S. Medical College, Mumbai, India