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Effectiveness of Intravenous Isoniazid and Ethambutol Administration in Patients with Tuberculosis Meningoencephalitis and HIV Infection
Yurii Feshchenko (National Institute of Phthisiology and Pulmonology named after F. G. Yanovskyi NAMS of Ukraine)
Mykhailo Kuzhko (National Institute of Phthisiology and Pulmonology named after F. G. Yanovskyi NAMS of Ukraine)
Mykola Gumenuik (National Institute of Phthisiology and Pulmonology named after F. G. Yanovskyi NAMS of Ukraine)
Kateryna Yurko (Kharkiv National Medical University)
Alina Grygorova (Kharkiv National Medical University)
Anton Tkachenko (Kharkiv National Medical University)
Natalia Nekrasova (Kharkiv National Medical University)
Tetiana Tlustova (National Institute of Phthisiology and Pulmonology named after F. G. Yanovskyi NAMS of Ukraine)
Vasyl Kikinchuk (Kharkiv National University of Internal Affairs)
Alexandr Peshenko (Kharkiv National University of Internal Affairs)
Tetiana Butova (V.N. Karazin Kharkiv National University)
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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.
- keywords
- Tuberculosis, Tuberculous Meningitis, Human Immunodeficiency Virus, Treatment, Isoniazid, Ethambutol
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