Chemotherapy for Tuberculous Meningitis

Researchers from the Oxford University Clinical Research Unit in Vietnam have completed what is probably the largest ever controlled trial of tuberculous meningitis. The study is published in the New England Journal of Medicine


Tuberculous meningitis is the most destructive form of the disease, with tuberculosis bacteria infecting the thin sheaths covering the central nervous system, resuling in fever and headaches. One third of infected patients die, despite current treatment. 

Guy Thwaites and his colleagues therefore tested whether an intensified antituberculosis treatment (higher doses of a currently used antibiotic, rifampin, combined with another antibiotic, levofloxacin) might help improve survival rates. 

Unfortunately, this carefully controlled study found that this more intensive treatment did not improve death rates. The results contradict the findings from some previous studies which suggest that upping the dose of rifampin and adding in another class of antibiotics improves outcomes for patients with tuberculous meningitis. Giving rifampin intravenously, or newer antituberculosis drugs may have an effect, but this needs to be tested. 

In the meantime, the best way of avoiding deaths from tuberculous meningitis is likely to continue to be early diagnosis and treatment.