ReviewCerebrospinal fluid concentrations of antituberculosis agents in adults and children
Section snippets
Introduction and methodology
Tuberculous meningitis (TBM) is the most destructive complication of tuberculosis causing considerable mortality and morbidity despite the availability of antituberculosis agents that successfully treat pulmonary and other forms of tuberculosis. Although the stage of disease when treatment is commenced is a critical determinant of outcome, even patients at an early disease stage may deteriorate, despite apparently appropriate management.1 It is, thus, essential that optimal use be made of
Isoniazid
INH has a low MIC in liquid media of 0.02–0.04 μg/ml,4 excellent pharmacokinetics and is easily absorbed and distributed throughout the body and has the highest early bactericidal activity (EBA) of all current antituberculosis agents5 and, for this reason, is the best agent to protect companion drugs against resistance6; conversely it is usually the first agent to which a population of Mycobacterium tuberculosis will become resistant.
Clinical experience in pulmonary tuberculosis patients
Discussion
During the last two decades, based on considerable experience with pulmonary tuberculosis, the chemotherapy of all forms of tuberculosis has become standardized to a six-month regimen incorporating the “essential” drugs INH, RMP, PZA, EMB for two months followed by INH and RMP for four months or INH and EMB for six months. In the 2003 Guidelines for National Programmes WHO recommended this regimen for TBM, but suggested that EMB should be replaced by SM.67 None the less this regimen has not
Acknowledgements
I am greatly indebted to the librarians of the Medical Library of the Faculty of Health Sciences, Stellenbosch University for their assistance in finding many papers that were not available in South Africa. PRD is supported by the National Research Foundation of South Africa.
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