Clinical outcomes among patients with tuberculous meningitis receiving intensified treatment regimens

• Authors: AGC Smith, Emory University; M Gujabidze, National Center for Tuberculosis and Lung Diseases; T Avaliani, National Center for Tuberculosis and Lung Diseases; Henry Blumberg, Emory University; Jeffrey Collins, Emory University; S Sabanadze, National Center for Tuberculosis and Lung Diseases; T Bakuradze, National Center for Tuberculosis and Lung Diseases; Z Avaliani, National Center for Tuberculosis and Lung Diseases; Russell Kempker, Emory University; M Kipiani, National Center for Tuberculosis and Lung Diseases
• Journal Title: INTERNATIONAL JOURNAL OF TUBERCULOSIS AND LUNG DISEASE
• Volume: Volume 25, Number 8
• Publisher: INT UNION AGAINST TUBERCULOSIS LUNG DISEASE (I U A T L D) | 2021-08-01, Pages 632-+
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.5588/ijtld.21.0159
• Subjects: Health Sciences, Medicine and Surgery; Health Sciences, Epidemiology
• Keywords: Science & Technology; Life Sciences & Biomedicine; Infectious Diseases; Respiratory System; multidrug-resistant; TBM; mortality; neurologic outcomes; empiric regimen; linezolid; CEREBROSPINAL-FLUID; PHARMACOKINETICS; PLASMA; SCALE

Abstract

S E T T ING: 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. RESULT S : 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 multidrugresistant 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.