title: Short intensified treatment in children with drug-susceptible tuberculous meningitis.
abstract: BACKGROUND
  The World Health Organization recommends 12-month treatment (2RHZE/10RH) for children with tuberculous meningitis (TBM). Studies evaluating length of antituberculous treatment for TBM report similar completion and relapse rates comparing 6-month treatment with 12-month treatment.
  
  
  METHODS
  A prospective evaluation to determine whether short-course intensified treatment (6 RHZEth for HIV-infected and 9RHZEth for HIV-infected) is sufficient and safe in children with drug-susceptible TBM.
  
  
  RESULTS
  Of 184 children with TBM, median age 58 months and 90 (49%) male, 98 children (53%) presented at stage II TBM, 64 (35%) at stage III TBM and only 22 (12%) at stage I TBM. Ninety (49%) children were treated at home after the first month of therapy; all others received their full treatment in hospital. The HIV prevalence was 14% (22/155 children tested). Anti-TB drug-induced hepatotoxicity occurred in 5% (8 of 143 children tested), all tested negative for viral hepatitis; in all 8 cases, the original regimen was restarted without recurrence. After treatment completion, 147 (80%) children had a good outcome, 7 (3.8%) died. There was no difference in outcome between HIV-infected and HIV-uninfected children who completed treatment (P = 0.986) nor between TBM-hydrocephalic children who were medically treated or shunted (P = 0.166).
  
  
  CONCLUSIONS
  Short intensified treatment is safe and effective in both HIV-infected and HIV-uninfected children with drug-susceptible TBM.
authors.affiliation: From the *Department of Pediatrics and Child Health, Stellenbosch University and Tygerberg Children's Hospital, Western Cape; †Biostatistics Unit, Medical Research Council of South Africa, Tygerberg, Cape Town, South Africa; and ‡Department of Pediatric Infectious Diseases and Immunology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Ronald
authors.initials: R
authors.lastname: van Toorn
authors.forename: H Simon
authors.initials: HS
authors.lastname: Schaaf
authors.forename: Jacoba A
authors.initials: JA
authors.lastname: Laubscher
authors.forename: Sabine L
authors.initials: SL
authors.lastname: van Elsland
authors.forename: Peter R
authors.initials: PR
authors.lastname: Donald
authors.forename: Johan F
authors.initials: JF
authors.lastname: Schoeman
mesh_terms: D000293:Adolescent; D000995:Antitubercular Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology; D006801:Humans; D007223:Infant; D008297:Male; D011446:Prospective Studies; D013019:South Africa / Q000453:epidemiology; D016896:Treatment Outcome; D014390:Tuberculosis, Meningeal / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology
chemical_list: D000995:Antitubercular Agents