Directly observed treatment, short course in tuberculous meningitis: Indian perspective

Sharma, Shailesh; Lynrah, Kyrshanlang G; Sharma, Neeraj; Lyngdoh, Markordor

doi:10.4103/0972-2327.107717

Cited by 7 publications

(29 citation statements)

References 7 publications

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“…The seven cohorts were from single tertiary centres in Thailand (Chotmongkol 1991; Chotmongkol 1996; Jacobs 1992), South Africa (Donald 1998; van Toorn 2014), Ecuador (Alarcón 1990), and Papua New Guinea (Biddulph 1990). Four studies were conducted in the 1980s (Alarcón 1990; Biddulph 1990; Chotmongkol 1991; Jacobs 1992), two in the 1990s (Chotmongkol 1996; Donald 1998), and one between 2006 and 2009 (van Toorn 2014).…”

Section: Resultsmentioning

confidence: 99%

“…Four studies were conducted in the 1980s (Alarcón 1990; Biddulph 1990; Chotmongkol 1991; Jacobs 1992), two in the 1990s (Chotmongkol 1996; Donald 1998), and one between 2006 and 2009 (van Toorn 2014). …”

Section: Resultsmentioning

confidence: 99%

“…Some study authors report that six months were adequate for treating TBM (Donald 1998; van Toorn 2014), while prolonged regimens have disadvantages. Prolonged regimens may increase the risk of drug-related adverse events and are associated with poor adherence to treatment and default.…”

Section: Introductionmentioning

confidence: 99%

“…Although several studies have reported safe outcomes in adults and children with TBM treated with six months regimens (Donald 1998; van Toorn 2014), there are concerns about whether six months regimens would be sufficient to sterilize CSF and thus prevent relapse. Most international guidelines recommend prolonged-course ATT of nine to 12 months for people with drug-sensitive TBM.…”

Section: Introductionmentioning

confidence: 99%

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Six months therapy for tuberculous meningitis

Jullien¹,

Ryan

Modi

et al. 2016

Cochrane Database of Systematic Reviews

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BackgroundTuberculous meningitis (TBM) is the main form of tuberculosis that affects the central nervous system and is associated with high rates of death and disability. Most international guidelines recommend longer antituberculous treatment (ATT) regimens for TBM than for pulmonary tuberculosis disease to prevent relapse. However, longer regimens are associated with poor adherence, which could contribute to increased relapse, development of drug resistance, and increased costs to patients and healthcare systems.ObjectivesTo compare the effects of short-course (six months) regimens versus prolonged-course regimens for people with tuberculous meningitis (TBM).Search methodsWe searched the following databases up to 31 March 2016: the Cochrane Infectious Diseases Group Specialized Register; the Cochrane Central Register of Controlled Trials (CENTRAL), published in the Cochrane Library; MEDLINE; EMBASE; LILACS; INDMED; and the South Asian Database of Controlled Clinical Trials. We searched the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) and ClinicalTrials.gov for ongoing trials. We also checked article reference lists and contacted researchers in the field.Selection criteriaWe included randomized controlled trials (RCTs) and prospective cohort studies of adults and children with TBM treated with antituberculous regimens that included rifampicin for six months or longer than six months. The primary outcome was relapse, and included studies required a minimum of six months follow-up after completion of treatment.Data collection and analysisTwo review authors (SJ and HR) independently assessed the literature search results for eligibility, and performed data extraction and 'Risk of bias' assessments of the included studies. We contacted study authors for additional information when necessary. Most data came from single arm cohort studies without a direct comparison so we pooled the findings for each group of cohorts and presented them separately using a complete-case analysis. We assessed the quality of the evidence narratively, as using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was inappropriate with no direct comparisons between short- and prolonged-course regimens.Main resultsFour RCTs and 12 prospective cohort studies met our inclusion criteria, and included a total of 1881 participants with TBM. None of the included RCTs directly compared six months versus longer regimens, so we analysed all data as individual cohorts to obtain relapse rates in each set of cohorts.We included seven cohorts of participants treated for six months, with a total of 458 participants. Three studies were conducted in Thailand, two in South Africa, and one each in Ecuador and Papua New Guinea between the 1980s and 2009. We included 12 cohorts of participants treated for longer than six months (ranging from eight to 16 months), with a total of 1423 participants. Four studies were conducted in India, three in Thailand and one each in China, South Africa,...

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Six months therapy for tuberculous meningitis

Jullien¹,

Ryan

Modi

et al. 2016

Cochrane Database of Systematic Reviews

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“…[789] Hence, we do not have evidence that the intermittent regimen is as good/superior/inferior to the daily regimen. We need follow-up studies in patients on intermittent regimen to guide national policies.…”

Section: Introductionmentioning

confidence: 99%

Major outcomes of patients with tuberculous meningitis on directly observed thrice a week regime

Iype

Pillai

Cherian

et al. 2014

Ann Indian Acad Neurol

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Background:Revised National Tuberculosis Control Programme (RNTCP) of Government of India provides intermittent thrice-a-week directly observed treatment short course (RNTCP regimen).Objective:Assessments of all-cause mortality and nine-month morbidity outcomes of patients with tuberculous meningitis (TBM) on RNTCP regimen.Materials and Methods:We prospectively followed up patients registered with RNTCP center, with a diagnosis of TBM from January 1st, 2010 to December 31st, 2011. Morbidity was assessed using modified Rankin Scale (mRS).Results:We had 43 patients with median duration for follow-up of 396 days and that of survivors of 425 days. Two patients defaulted. Fourteen patients (32.5%) had mRS score of 4 to 6 and 29 had mRS of 0 to 3 after 9-month treatment. Severe disability was not related to any factor on logistic regression. Severe disability was seen in one patient (6.66%) among the 15 patients with stage 1, nine (37.5%) out of 24 patients with stage 2 and three (75%) out of 4 patients with stage 3 disease. Eight patients died (18.6%) of whom 4 died during the intensive phase and 4 during the continuation phase of RNTCP regimen. Mortality was independently related to treatment failure with adjusted Hazard ratio of 8.29 (CI: 1.38-49.78) (P = 0.02). One patient (6.66%) died out of the 15 patients with stage 1 disease, 5 (20.8%) out of 24 patients with stage 2 disease and 2 (50%) out of the 4 with stage 3 disease.Discussion and Conclusion:RNTCP regimen was associated with good compliance, comparable mortality and morbidity.

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