Intensified Tx doesn't up survival in tuberculous meningitis

(HealthDay)—For patients with tuberculous meningitis, intensified antituberculosis treatment is not associated with higher survival than standard treatment, according to a study published in the Jan. 14 issue of the New England Journal of Medicine.

A. Dorothee Heemskerk, M.D., from the Oxford University Clinical Research Unit in the United Kingdom, and colleagues performed a randomized placebo-controlled trial involving HIV-infected adults and uninfected adults with a clinical diagnosis of tuberculous meningitis. A standard nine-month antituberculosis regimen (including 10 mg/kg body weight of rifampin/day) was compared with an intensified regimen that included higher-dose rifampin and levofloxacin. A total of 817 patients were enrolled (349 HIV-infected); 409 and 408 were randomized to the standard regimen and intensified treatment, respectively.

The researchers found that 113 patients in the intensified-treatment group and 114 in the standard-treatment group died during the nine months after follow-up (hazard ratio, 0.94; 95 percent confidence interval, 0.73 to 1.22). No evidence of a significant differential effect of intensified treatment was seen in the overall population, or in any subgroups, except possibly for patients infected with isoniazid-resistant Mycobacterium tuberculosis. Secondary outcomes did not differ significantly between the treatment groups. There was no significant between-group difference in the overall number of adverse events leading to treatment interruption (P = 0.08).

"Intensified antituberculosis treatment was not associated with a higher rate of survival among patients with tuberculous meningitis than standard treatment," the authors write.

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