Template:ID-Tuberculous meningitis: Difference between revisions

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* Tuberculous meningitis (TB meningitis)
* Tuberculous meningitis (TB meningitis)
:* '''First-line therapy'''
:* '''First-line therapy''' (dosing information: <span class="plainlinks">[http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5211a1.htm#tab3]</span><span class="plainlinks">[http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5211a1.htm#tab4]</span><span class="plainlinks">[http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5211a1.htm#tab5]</span>)
::* [[Isoniazid]]
::* [[Isoniazid]]
::* [[Rifampin]]
::* [[Rifampin]]
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::* [[Ethambutol]]
::* [[Ethambutol]]


:* '''Second-line therapy'''
:* '''Second-line therapy''' (dosing information: <span class="plainlinks">[http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5211a1.htm#tab3]</span><span class="plainlinks">[http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5211a1.htm#tab4]</span><span class="plainlinks">[http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5211a1.htm#tab5]</span>)
::* [[Cycloserine]]
::* [[Cycloserine]]
::* [[Ethionamide]]
::* [[Ethionamide]]
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::* [[Moxifloxacin]]
::* [[Moxifloxacin]]
::* [[Gatifloxacin]]
::* [[Gatifloxacin]]
::: (Dosing information: <span class="plainlinks">[http://ww.cdc.gov/mmwr/preview/mmwrhtml/rr5211a1.htm#tab3]</span><span class="plainlinks">[http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5211a1.htm#tab4]</span><span class="plainlinks">[http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5211a1.htm#tab5]</span>)


:* Tuberculous meningitis caused by susceptible Mycobacterium tuberculosis<ref>{{Cite journal| doi = 10.1164/rccm.167.4.603| issn = 1073-449X| volume = 167| issue = 4| pages = 603–662| last1 = Blumberg| first1 = Henry M.| last2 = Burman| first2 = William J.| last3 = Chaisson| first3 = Richard E.| last4 = Daley| first4 = Charles L.| last5 = Etkind| first5 = Sue C.| last6 = Friedman| first6 = Lloyd N.| last7 = Fujiwara| first7 = Paula| last8 = Grzemska| first8 = Malgosia| last9 = Hopewell| first9 = Philip C.| last10 = Iseman| first10 = Michael D.| last11 = Jasmer| first11 = Robert M.| last12 = Koppaka| first12 = Venkatarama| last13 = Menzies| first13 = Richard I.| last14 = O'Brien| first14 = Richard J.| last15 = Reves| first15 = Randall R.| last16 = Reichman| first16 = Lee B.| last17 = Simone| first17 = Patricia M.| last18 = Starke| first18 = Jeffrey R.| last19 = Vernon| first19 = Andrew A.| last20 = American Thoracic Society, Centers for Disease Control and Prevention and the Infectious Diseases Society| title = American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: treatment of tuberculosis| journal = American Journal of Respiratory and Critical Care Medicine| date = 2003-02-15| pmid = 12588714}}</ref><ref>{{Cite journal| doi = 10.1128/CMR.00042-07| issn = 1098-6618| volume = 21| issue = 2| pages = 243–261, table of contents| last1 = Rock| first1 = R. Bryan| last2 = Olin| first2 = Michael| last3 = Baker| first3 = Cristina A.| last4 = Molitor| first4 = Thomas W.| last5 = Peterson| first5 = Phillip K.| title = Central nervous system tuberculosis: pathogenesis and clinical aspects| journal = Clinical Microbiology Reviews| date = 2008-04| pmid = 18400795| pmc = PMC2292571}}</ref><ref>{{Cite journal| doi = 10.1016/j.jinf.2009.06.011| issn = 1532-2742| volume = 59| issue = 3| pages = 167–187| last1 = Thwaites| first1 = Guy| last2 = Fisher| first2 = Martin| last3 = Hemingway| first3 = Cheryl| last4 = Scott| first4 = Geoff| last5 = Solomon| first5 = Tom| last6 = Innes| first6 = John| last7 = British Infection Society| title = British Infection Society guidelines for the diagnosis and treatment of tuberculosis of the central nervous system in adults and children| journal = The Journal of Infection| date = 2009-09| pmid = 19643501}}</ref><ref>{{Cite journal| issn = 1057-5987| volume = 52| issue = RR-11| pages = 1–77| last1 = American Thoracic Society| last2 = CDC| last3 = Infectious Diseases Society of America| title = Treatment of tuberculosis| journal = MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control| date = 2003-06-20| pmid = 12836625}}</ref>
:* Tuberculous meningitis caused by susceptible Mycobacterium tuberculosis<ref>{{Cite journal| doi = 10.1164/rccm.167.4.603| issn = 1073-449X| volume = 167| issue = 4| pages = 603–662| last1 = Blumberg| first1 = Henry M.| last2 = Burman| first2 = William J.| last3 = Chaisson| first3 = Richard E.| last4 = Daley| first4 = Charles L.| last5 = Etkind| first5 = Sue C.| last6 = Friedman| first6 = Lloyd N.| last7 = Fujiwara| first7 = Paula| last8 = Grzemska| first8 = Malgosia| last9 = Hopewell| first9 = Philip C.| last10 = Iseman| first10 = Michael D.| last11 = Jasmer| first11 = Robert M.| last12 = Koppaka| first12 = Venkatarama| last13 = Menzies| first13 = Richard I.| last14 = O'Brien| first14 = Richard J.| last15 = Reves| first15 = Randall R.| last16 = Reichman| first16 = Lee B.| last17 = Simone| first17 = Patricia M.| last18 = Starke| first18 = Jeffrey R.| last19 = Vernon| first19 = Andrew A.| last20 = American Thoracic Society, Centers for Disease Control and Prevention and the Infectious Diseases Society| title = American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: treatment of tuberculosis| journal = American Journal of Respiratory and Critical Care Medicine| date = 2003-02-15| pmid = 12588714}}</ref><ref>{{Cite journal| doi = 10.1128/CMR.00042-07| issn = 1098-6618| volume = 21| issue = 2| pages = 243–261, table of contents| last1 = Rock| first1 = R. Bryan| last2 = Olin| first2 = Michael| last3 = Baker| first3 = Cristina A.| last4 = Molitor| first4 = Thomas W.| last5 = Peterson| first5 = Phillip K.| title = Central nervous system tuberculosis: pathogenesis and clinical aspects| journal = Clinical Microbiology Reviews| date = 2008-04| pmid = 18400795| pmc = PMC2292571}}</ref><ref>{{Cite journal| doi = 10.1016/j.jinf.2009.06.011| issn = 1532-2742| volume = 59| issue = 3| pages = 167–187| last1 = Thwaites| first1 = Guy| last2 = Fisher| first2 = Martin| last3 = Hemingway| first3 = Cheryl| last4 = Scott| first4 = Geoff| last5 = Solomon| first5 = Tom| last6 = Innes| first6 = John| last7 = British Infection Society| title = British Infection Society guidelines for the diagnosis and treatment of tuberculosis of the central nervous system in adults and children| journal = The Journal of Infection| date = 2009-09| pmid = 19643501}}</ref><ref>{{Cite journal| issn = 1057-5987| volume = 52| issue = RR-11| pages = 1–77| last1 = American Thoracic Society| last2 = CDC| last3 = Infectious Diseases Society of America| title = Treatment of tuberculosis| journal = MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control| date = 2003-06-20| pmid = 12836625}}</ref>
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:::* Consider Ethionamide or Cycloserine to build the treatment regimen.
:::* Consider Ethionamide or Cycloserine to build the treatment regimen.
:::* Consult infectious disease specialist.
:::* Consult infectious disease specialist.
==References==
{{reflist|2}}

Latest revision as of 20:16, 11 August 2015

  • Tuberculous meningitis (TB meningitis)
  • First-line therapy (dosing information: [1][2][3])
  • Second-line therapy (dosing information: [4][5][6])
  • Tuberculous meningitis caused by susceptible Mycobacterium tuberculosis[1][2][3][4]
  • Intensive phase (adult)
  • Preferred regimen: Isoniazid 5 mg/kg (max: 300 mg) for 2 months AND Rifampin 10 mg/kg (max: 600 mg) for 2 months AND Pyrazinamide 15–30 mg/kg (max: 2 g) for 2 months AND Ethambutol 15–20 mg/kg (max: 1 g) for 2 months
  • Continuation phase (adult)
  • Preferred regimen: Isoniazid 5 mg/kg (max: 300 mg) for 7–10 months AND Rifampin 10 mg/kg (max: 600 mg) for 7–10 months
  • Intensive phase (pediatric)
  • Preferred regimen: Isoniazid 10–15 mg/kg (max: 300 mg) for 2 months AND Rifampin 10–20 mg/kg (max: 600 mg) for 2 months AND Pyrazinamide 15–30 mg/kg (max: 2 g) for 2 months AND Ethambutol 15–20 mg/kg (max: 1 g) for 2 months
  • Continuation phase (pediatric)
  • Preferred regimen: Isoniazid 10–15 mg/kg (max: 300 mg) for 7–10 months AND Rifampin 10–20 mg/kg (max: 600 mg) for 7–10 months
Note (1): World Health Organization guidelines recommend that Ethambutol should be replaced by Streptomycin (contraindicated in pregnancy) in tuberculous meningitis.[5]
Note (2): A 9– to 12–month course of treatment is recommended for tuberculous meningitis.[6][7]
Note (3): Adjuvant Dexamethasone 0.3–0.4 mg/kg/day (max: 24 mg) is recommended unless drug resistance is suspected.[8][9]
Note (4): Liaise with microbiology laboratory about genotype testing for drug resistance if there is high risk for MDR-TB.[10]
  • Tuberculous meningitis caused by Mycobacterium tuberculosis resistant to isoniazid or rifampin
  • Isoniazid monoresistance[11]
  • Substitute fluoroquinolone for isoniazid in intensive phase regimen.
  • Continue treatment with rifampin, pyrazinamide, and fluoroquinolone for 12 months.
  • Rifampin monoresistance[12]
  • Substitute Fluoroquinolones for Rifampin in intensive phase regimen.
  • Continue treatment with isoniazid, pyrazinamide, and fluoroquinolone for 18 months.
  • MDR-TB (resistant to Isoniazid and Rifampin)[13]
  • MDR tuberculosis therapy should be considered if there is a history of prior tuberculosis treatment, contact with a patient with MDR tuberculosis, or a poor clinical response to first-line TB therapy within 2 weeks despite a firm diagnosis and an adequate adherence to treatment.
  • Second-line agents such as Aminoglycosides penetrate the BBB only in the presence of inflamed meninges, and Fluoroquinolones, while able to penetrate into the CNS, have lower CSF levels than in the serum or brain parenchyma.
  • Consult infectious disease specialist.
  • XDR-TB (resistant to Isoniazid, Rifampin, Fluoroquinolones, and either Capreomycin, Kanamycin, or Amikacin)[14]
  • Consider Ethionamide or Cycloserine to build the treatment regimen.
  • Consult infectious disease specialist.

References

  1. ↑ Blumberg, Henry M.; Burman, William J.; Chaisson, Richard E.; Daley, Charles L.; Etkind, Sue C.; Friedman, Lloyd N.; Fujiwara, Paula; Grzemska, Malgosia; Hopewell, Philip C.; Iseman, Michael D.; Jasmer, Robert M.; Koppaka, Venkatarama; Menzies, Richard I.; O'Brien, Richard J.; Reves, Randall R.; Reichman, Lee B.; Simone, Patricia M.; Starke, Jeffrey R.; Vernon, Andrew A.; American Thoracic Society, Centers for Disease Control and Prevention and the Infectious Diseases Society (2003-02-15). "American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: treatment of tuberculosis". American Journal of Respiratory and Critical Care Medicine. 167 (4): 603–662. doi:10.1164/rccm.167.4.603. ISSN 1073-449X. PMID 12588714.
  2. ↑ Rock, R. Bryan; Olin, Michael; Baker, Cristina A.; Molitor, Thomas W.; Peterson, Phillip K. (2008-04). "Central nervous system tuberculosis: pathogenesis and clinical aspects". Clinical Microbiology Reviews. 21 (2): 243–261, table of contents. doi:10.1128/CMR.00042-07. ISSN 1098-6618. PMC 2292571. PMID 18400795. Check date values in: |date= (help)
  3. ↑ Thwaites, Guy; Fisher, Martin; Hemingway, Cheryl; Scott, Geoff; Solomon, Tom; Innes, John; British Infection Society (2009-09). "British Infection Society guidelines for the diagnosis and treatment of tuberculosis of the central nervous system in adults and children". The Journal of Infection. 59 (3): 167–187. doi:10.1016/j.jinf.2009.06.011. ISSN 1532-2742. PMID 19643501. Check date values in: |date= (help)
  4. ↑ American Thoracic Society; CDC; Infectious Diseases Society of America (2003-06-20). "Treatment of tuberculosis". MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control. 52 (RR-11): 1–77. ISSN 1057-5987. PMID 12836625.
  5. ↑ Treatment of Tuberculosis: Guidelines. WHO Guidelines Approved by the Guidelines Review Committee (4th ed.). Geneva: World Health Organization. 2010. ISBN 9789241547833. PMID 23741786.
  6. ↑ Treatment of Tuberculosis: Guidelines. WHO Guidelines Approved by the Guidelines Review Committee (4th ed.). Geneva: World Health Organization. 2010. ISBN 9789241547833. PMID 23741786.
  7. ↑ American Thoracic Society; CDC; Infectious Diseases Society of America (2003-06-20). "Treatment of tuberculosis". MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control. 52 (RR-11): 1–77. ISSN 1057-5987. PMID 12836625.
  8. ↑ Thwaites, Guy E.; Nguyen, Duc Bang; Nguyen, Huy Dung; Hoang, Thi Quy; Do, Thi Tuong Oanh; Nguyen, Thi Cam Thoa; Nguyen, Quang Hien; Nguyen, Tri Thuc; Nguyen, Ngoc Hai; Nguyen, Thi Ngoc Lan; Nguyen, Ngoc Lan; Nguyen, Hong Duc; Vu, Ngoc Tuan; Cao, Huu Hiep; Tran, Thi Hong Chau; Pham, Phuong Mai; Nguyen, Thi Dung; Stepniewska, Kasia; White, Nicholas J.; Tran, Tinh Hien; Farrar, Jeremy J. (2004-10-21). "Dexamethasone for the treatment of tuberculous meningitis in adolescents and adults". The New England Journal of Medicine. 351 (17): 1741–1751. doi:10.1056/NEJMoa040573. ISSN 1533-4406. PMID 15496623.
  9. ↑ Thwaites, Guy; Fisher, Martin; Hemingway, Cheryl; Scott, Geoff; Solomon, Tom; Innes, John; British Infection Society (2009-09). "British Infection Society guidelines for the diagnosis and treatment of tuberculosis of the central nervous system in adults and children". The Journal of Infection. 59 (3): 167–187. doi:10.1016/j.jinf.2009.06.011. ISSN 1532-2742. PMID 19643501. Check date values in: |date= (help)
  10. ↑ Thwaites, Guy; Fisher, Martin; Hemingway, Cheryl; Scott, Geoff; Solomon, Tom; Innes, John; British Infection Society (2009-09). "British Infection Society guidelines for the diagnosis and treatment of tuberculosis of the central nervous system in adults and children". The Journal of Infection. 59 (3): 167–187. doi:10.1016/j.jinf.2009.06.011. ISSN 1532-2742. PMID 19643501. Check date values in: |date= (help)
  11. ↑ Thwaites, Guy; Fisher, Martin; Hemingway, Cheryl; Scott, Geoff; Solomon, Tom; Innes, John; British Infection Society (2009-09). "British Infection Society guidelines for the diagnosis and treatment of tuberculosis of the central nervous system in adults and children". The Journal of Infection. 59 (3): 167–187. doi:10.1016/j.jinf.2009.06.011. ISSN 1532-2742. PMID 19643501. Check date values in: |date= (help)
  12. ↑ Thwaites, Guy; Fisher, Martin; Hemingway, Cheryl; Scott, Geoff; Solomon, Tom; Innes, John; British Infection Society (2009-09). "British Infection Society guidelines for the diagnosis and treatment of tuberculosis of the central nervous system in adults and children". The Journal of Infection. 59 (3): 167–187. doi:10.1016/j.jinf.2009.06.011. ISSN 1532-2742. PMID 19643501. Check date values in: |date= (help)
  13. ↑ Rock, R. Bryan; Olin, Michael; Baker, Cristina A.; Molitor, Thomas W.; Peterson, Phillip K. (2008-04). "Central nervous system tuberculosis: pathogenesis and clinical aspects". Clinical Microbiology Reviews. 21 (2): 243–261, table of contents. doi:10.1128/CMR.00042-07. ISSN 1098-6618. PMC 2292571. PMID 18400795. Check date values in: |date= (help)
  14. ↑ Rock, R. Bryan; Olin, Michael; Baker, Cristina A.; Molitor, Thomas W.; Peterson, Phillip K. (2008-04). "Central nervous system tuberculosis: pathogenesis and clinical aspects". Clinical Microbiology Reviews. 21 (2): 243–261, table of contents. doi:10.1128/CMR.00042-07. ISSN 1098-6618. PMC 2292571. PMID 18400795. Check date values in: |date= (help)
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