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

Affiliations
  • 1Department of Phthisiology and Pulmonology, Kharkiv National Medical University, Kharkiv, Ukraine. dddimad@gmail.com
  • 2Department of Technologies of Treatment of Nonspecific Lung Diseases, National Institute of Phthisiology and Pulmonology named after F. G. Yanovskyi NAMS of Ukraine, Kiev, Ukraine.
  • 3Department of Resistent Tuberculosis, National Institute of Phthisiology and Pulmonology named after F. G. Yanovskyi NAMS of Ukraine, Kiev, Ukraine.
  • 4Department of Infectious Diseases, Kharkiv National Medical University, Kharkiv, Ukraine.
  • 5Department of Research, Kharkiv National Medical University, Kharkiv, Ukraine.
  • 6Department of Biochemistry, Kharkiv National Medical University, Kharkiv, Ukraine.
  • 7Department of Neurology, Kharkiv National Medical University, Kharkiv, Ukraine.
  • 8Department of Medicine, National Institute of Phthisiology and Pulmonology named after F. G. Yanovskyi NAMS of Ukraine, Kiev, Ukraine.
  • 9Department of Criminalistics and Forensic Science, Kharkiv National University of Internal Affairs, Kharkiv, Ukraine.
  • 10Department of Internal Medicine, V.N. Karazin Kharkiv National University, Kharkiv, Ukraine.

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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