Tuberc Respir Dis.  2020 Jan;83(1):96-103. 10.4046/trd.2019.0021.

Effectiveness of Intravenous Isoniazid and Ethambutol Administration in Patients with Tuberculosis Meningoencephalitis and HIV Infection

• Butov D
• Feshchenko Y
• Kuzhko M
• Gumenuik M
• Yurko K
• Grygorova
• Tkachenko
• Nekrasova
• Tlustova T
• Kikinchuk
• Peshenko A
• Butova T

• KMID: 2466625
• DOI: http://doi.org/10.4046/trd.2019.0021

Abstract

BACKGROUND
The aim of this study was to investigate the effectiveness of intravenous isoniazid (H) and ethambutol (E) administered in patients with new sputum positive drug-susceptible pulmonary tuberculosis (TB) with tuberculous meningoencephalitis (TM) and human immunodeficiency virus (HIV) co-infection in the intensive phase of treatment.
METHODS
Fifty-four patients with TB/TM and HIV co-infection were enrolled for this study. Group 1 comprised of 23 patients treated with E and H intravenously, while rifampicin and pyrazinamide were prescribed orally. Group 2 consisted of 31 patients treated with the first-line anti-TB drugs orally. The concentrations of H and E in blood serum were detected using a chromatographic method.
RESULTS
A significant improvement in the clinical symptoms and X-ray signs in patients treated intravenously with H and E was observed and compared to group 2. The sputum Mycobacterium tuberculosis positivity was observed during the second month of the treatment in 25.0% of patients from group 1 and 76.1% of the patients from the control group (p=0.003). In addition, nine patients (39.1%) died up to 6 months when H and E were prescribed intravenously compared with 22 (70.9%) in group 2 (p=0.023).
CONCLUSION
In TB/TM with HIV, the intravenous H and E treatment was more effective than oral H and E treatment at 2 months of intensive treatment in sputum conversion as well as in clinical improvement, accompanied by significantly higher mean serum concentrations. In addition, the mortality rate was lower in intravenous H and E treatment compared to oral treatment.

Keyword

Tuberculosis; Tuberculous Meningitis; Human Immunodeficiency Virus; Treatment; Isoniazid; Ethambutol

MeSH Terms

Coinfection
Ethambutol*
HIV Infections*
HIV*
Humans
Isoniazid*
Meningoencephalitis*
Methods
Mortality
Mycobacterium tuberculosis
Pyrazinamide
Rifampin
Serum
Sputum
Tuberculosis*
Tuberculosis, Meningeal
Tuberculosis, Pulmonary
Ethambutol
Isoniazid
Pyrazinamide
Rifampin

Figure

• 

  Figure 1 Average concentrations of isoniazid in blood serum of patients depending on the time of sample collection. *Differences between independent variables of group 1 and group 2 were considered statistically significant at p<0.05.

• 

  Figure 2 Average concentrations of ethalbutol in blood serum of patients depending on the time of sample collection. *Differences between independent variables of group 1 and group 2 were considered statistically significant at p<0.05.

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