Donald P R, Schoeman J F, Van Zyl L E, De Villiers J N, Pretorius M, Springer P
Department of Paediatrics and Child Health, University of Stellenbosch and Tygerberg Hospital, South Africa.
Int J Tuberc Lung Dis. 1998 Sep;2(9):704-11.
Short course chemotherapy for tuberculous meningitis (TBM) is advocated by several groups, but relatively few children have been so treated and followed up.
A prospective, observational study of isoniazid (INH), rifampicin (RMP) and ethionamide (ETH) in a dosage of 20 mg/kg, and pyrazinamide (PZA) 40 mg/kg, all given once daily in hospital for 6 months. Surviving children were followed up for a year after discharge.
Ninety five children, 39 (41%) at stage III, 52 (55%) at stage II and 4 (4%) at stage I TBM were studied. Ten (26%) at stage III and 3 (6%) at stage II died before completion of therapy. Five surviving children (6%) moved on discharge and were untraceable; seven children (9%) were lost during follow up and three were inadvertently restarted on antituberculosis therapy. Two children with severe stage III disease died after discharge. One child experienced a probable disease recrudescence 1 month after discharge. Eighteen children (20%) developed a mildly elevated serum bilirubin concentration during the first month of treatment. In five of these children INH, RMP, ETH and PZA were stopped and streptomycin (SM) and ethambutol substituted. In all cases the original treatment was restarted without incident. One child developed overt jaundice after 5 months of treatment due to hepatitis A infection.
Our experience suggests that young children with TBM can be safely treated for 6 months with high doses of antituberculosis agents without overt hepatotoxicity and with a low risk of relapse.
多个研究小组主张采用短程化疗治疗结核性脑膜炎（TBM），但接受此类治疗并进行随访的儿童相对较少。
一项前瞻性观察研究，使用异烟肼（INH）、利福平（RMP）、剂量为20mg/kg的乙硫异烟胺（ETH）以及40mg/kg的吡嗪酰胺（PZA），所有药物均在医院每日给药一次，持续6个月。存活儿童出院后随访一年。
研究了95名儿童，其中39名（41%）处于TBM III期，52名（55%）处于II期，4名（4%）处于I期。III期的10名（26%）和II期的3名（6%）在治疗完成前死亡。5名存活儿童（6%）出院后搬走，无法追踪；7名儿童（9%）在随访期间失访，3名儿童在抗结核治疗中被无意重新开始治疗。两名患有严重III期疾病的儿童出院后死亡。一名儿童在出院后1个月可能疾病复发。18名儿童（20%）在治疗的第一个月血清胆红素浓度轻度升高。其中5名儿童停用INH、RMP、ETH和PZA，改用链霉素（SM）和乙胺丁醇。所有情况下，原治疗均顺利重新开始。一名儿童在治疗5个月后因甲型肝炎感染出现明显黄疸。
我们的经验表明，患有TBM的幼儿可以安全地接受6个月的高剂量抗结核药物治疗，不会出现明显的肝毒性，复发风险也较低。
