Therapeutic drug monitoring of intravenous anti-tuberculous therapy: management of an 8-month-old child with tuberculous meningitis

ABSTRACT

Tuberculous meningitis (TBM) is now uncommon in high-income countries. It is the most severe form of extrapulmonary tuberculosis with high rates of mortality and morbidity if diagnosis and treatment are delayed. An 8-month-old girl with TBM who was treated with high-dose intravenous anti-tuberculous drugs (ATD) is reported. Therapeutic drug monitoring (TDM) of isoniazid and rifampicin was undertaken by measuring serial drug concentrations in serum and cerebrospinal fluid (CSF). There was rapid eradication of Mycobacterium tuberculosis from the CSF with a good clinical outcome and no adverse effects. Using high-dose regimens of intravenous ATD to treat TBM is an important option in order to obtain sufficient CSF diffusion. When available, TDM and a multidisciplinary approach are essential for efficient therapeutic management.

KEYWORDS:

• Pediatrics
• Tuberculosis, Central Nervous System
• Drug Monitoring
• Antitubercular Agents

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Notes on contributors

Lucie Huynh

Lucie Huyhh, PharmD is a clinical pharmacist and completed a specialized clinical internship in paediatric pharmaceutical care at Caen University Hospital.

Cedric Agossah

Cedric Agossah is completing his medical internship in Paediatrics at Caen University Hospital.

Véronique Lelong-Boulouard

Véronique Lelong-Boulouard, PharmD, PhD, is the head of the Pharmacology Department at Caen University Hospital. She is an associate professor at the School of Medicine of the Universiy of Normandy, Caen, France. Her research focuses on analytical and clinical pharmacology in collaboration with the INSERM URM, University of Normandy, Caen, France.

David Brossier

David Brossier, MD, PhD, is a paediatric intensivist working at the Pediatric Intensive Care Unit of Caen University Hospital. He is an associate professor at the School of Medicine of the Universiy of Normandy, Caen, France. His research focuses on high-resolution databases in the critical care unit, data quality assessment and cardio-respiratory computational modelling.

Isabelle Goyer

Isabelle Goyer, PharmD, MSc, is a specialized clinical pharmacist working at the Pharmacy Department of Caen University Hospital. She obtained a hospital clinical pharmacy diploma from University of Montreal, Montreal, Canada and completed a specialized clinical pharmacy fellowship in pediatric critical care.