Advancing the chemotherapy of tuberculous meningitis: a consensus view
Tuberculous meningitis causes death or disability in approximately 50% of affected individuals and kills approximately 78 200 adults every year. Antimicrobial treatment is based on regimens used for pulmonary tuberculosis, which overlooks important differences between lung and brain drug distributio...
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| Veröffentlicht in: | The Lancet infectious diseases 2025-01, Vol.25 (1), p.e47-e58 |
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| creator | Wasserman, Sean Donovan, Joseph Kestelyn, Evelyne Watson, James A Aarnoutse, Robert E Barnacle, James R Boulware, David R Chow, Felicia C Cresswell, Fiona V Davis, Angharad G Dooley, Kelly E Figaji, Anthony A Gibb, Diana M Huynh, Julie Imran, Darma Marais, Suzaan Meya, David B Misra, Usha K Modi, Manish Raberahona, Mihaja Ganiem, Ahmad Rizal Rohlwink, Ursula K Ruslami, Rovina Seddon, James A Skolimowska, Keira H Solomons, Regan S Stek, Cari J Thuong, Nguyen Thuy Thuong van Crevel, Reinout Whitaker, Claire Thwaites, Guy E Wilkinson, Robert J |
| description | Tuberculous meningitis causes death or disability in approximately 50% of affected individuals and kills approximately 78 200 adults every year. Antimicrobial treatment is based on regimens used for pulmonary tuberculosis, which overlooks important differences between lung and brain drug distributions. Tuberculous meningitis has a profound inflammatory component, yet only adjunctive corticosteroids have shown clear benefit. There is an active pipeline of new antitubercular drugs, and the advent of biological agents targeted at specific inflammatory pathways promises a new era of improved tuberculous meningitis treatment and outcomes. Yet, to date, tuberculous meningitis trials have been small, underpowered, heterogeneous, poorly generalisable, and have had little effect on policy and practice. Progress is slow, and a new approach is required. In this Personal View, a global consortium of tuberculous meningitis researchers articulate a coordinated, definitive way ahead via globally conducted clinical trials of novel drugs and regimens to advance treatment and improve outcomes for this life-threatening infection. |
| doi_str_mv | 10.1016/S1473-3099(24)00512-7 |
| format | Article |
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Antimicrobial treatment is based on regimens used for pulmonary tuberculosis, which overlooks important differences between lung and brain drug distributions. Tuberculous meningitis has a profound inflammatory component, yet only adjunctive corticosteroids have shown clear benefit. There is an active pipeline of new antitubercular drugs, and the advent of biological agents targeted at specific inflammatory pathways promises a new era of improved tuberculous meningitis treatment and outcomes. Yet, to date, tuberculous meningitis trials have been small, underpowered, heterogeneous, poorly generalisable, and have had little effect on policy and practice. Progress is slow, and a new approach is required. 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All rights reserved, including those for text and data mining, AI training, and similar technologies.</rights><rights>2025. 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Antimicrobial treatment is based on regimens used for pulmonary tuberculosis, which overlooks important differences between lung and brain drug distributions. Tuberculous meningitis has a profound inflammatory component, yet only adjunctive corticosteroids have shown clear benefit. There is an active pipeline of new antitubercular drugs, and the advent of biological agents targeted at specific inflammatory pathways promises a new era of improved tuberculous meningitis treatment and outcomes. Yet, to date, tuberculous meningitis trials have been small, underpowered, heterogeneous, poorly generalisable, and have had little effect on policy and practice. Progress is slow, and a new approach is required. 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| subjects | Acquired immune deficiency syndrome Adrenal Cortex Hormones - administration & dosage Adrenal Cortex Hormones - therapeutic use AIDS Antitubercular Agents - administration & dosage Antitubercular Agents - therapeutic use Chemotherapy Clinical trials Clinical Trials as Topic Consensus Corticoids Corticosteroids Drugs HIV Human immunodeficiency virus Humans Inflammation Meningitis Mortality Mycobacterium tuberculosis - drug effects Steroids Tuberculosis Tuberculosis, Meningeal - drug therapy |
| title | Advancing the chemotherapy of tuberculous meningitis: a consensus view |
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