title: Multidrug-resistant tuberculosis meningitis: clinical problems and concentrations of second-line antituberculous medications.
abstract: OBJECTIVE
  [corrected] To describe a case of culture-proven multidrug-resistant tuberculous (MDR-TB) meningitis, in which the patient survived long enough for clinicians to adjust antituberculous therapy to second-line therapeutic agents.
  
  
  METHODS
  Case report.
  
  
  METHODS
  Tertiary care hospital.
  
  
  METHODS
  Twenty-one-month-old girl with MDR-TB meningitis.
  
  
  METHODS
  Initial standard treatment failed. Subsequent treatment with second-line therapeutic agents including ciprofloxacin, cycloserine, ethambutol, ethionamide, and rifabutin were given for approximately two years. Concentrations of these drugs were measured in serum and cerebrospinal fluid in the presence and absence of meningeal inflammation.
  
  
  RESULTS
  The patient survived for approximately two years after initiation of second-line anti-TB therapy. During this treatment, she developed a ventriculo-peritoneal shunt tunnel tract infection secondary to MDR-TB.
  
  
  CONCLUSIONS
  All TB meningitis isolates for which the source case antibiotic susceptibility pattern is not known should be cultured and susceptibility tested using rapid broth techniques. Measurement and subsequent adjustment of therapeutic drug concentrations may optimize therapy with second-line anti-TB drugs in TB meningitis. Better pediatric formulations and pharmacokinetic data for second-line and anti-TB therapeutic agents are needed.
authors.affiliation: Division of Infectious Diseases, University of Tennessee, Memphis, USA. jdevincenzo@utmem1.utmem.edu
authors.forename: J P
authors.initials: JP
authors.lastname: DeVincenzo
authors.forename: S E
authors.initials: SE
authors.lastname: Berning
authors.forename: C A
authors.initials: CA
authors.lastname: Peloquin
authors.forename: R N
authors.initials: RN
authors.lastname: Husson
mesh_terms: D000995:Antitubercular Agents / Q000097:blood / Q000134:cerebrospinal fluid / Q000627:therapeutic use*; D004352:Drug Resistance, Microbial; D018432:Drug Resistance, Multiple; D005260:Female; D006801:Humans; D007223:Infant; D009169:Mycobacterium tuberculosis / Q000187:drug effects / Q000302:isolation & purification; D014390:Tuberculosis, Meningeal / Q000188:drug therapy* / Q000382:microbiology
chemical_list: D000995:Antitubercular Agents