Optimizing Pyrazinamide Use: A Low-Hanging Fruit in Improving Outcomes with Tuberculous Meningitis? Narrative Review.

IF 4.7 3区医学 Q1 INFECTIOUS DISEASES

Infectious Diseases and Therapy Pub Date : 2025-01-03 DOI:10.1007/s40121-024-01102-1

Bella Devaleenal Daniel, Leeberk Raja Inbaraj, Shanmugapriya Kumaravadivelu, Kathirvel Subramanian, Balaji Ramraj, Abi Manesh

引用次数: 0

Abstract

Tuberculous meningitis (TBM) disables more than a third of its sufferers. Recent research has focused on optimizing the antitubercular regimen, mainly by increasing the dosage of rifampicin. However, pyrazinamide, with higher penetration into the central nervous system, is generally overlooked. We discuss the potential clinical impact of using pyrazinamide throughout antitubercular therapy in TBM, in contrast to only the intensive phase. This approach may improve the treatment outcomes and reduce disability in TBM. We summarize the available data regarding this approach from in vitro studies, clinical cohorts, toxicity data, and baseline resistance rates. Additionally, we discuss the two ongoing clinical trials evaluating this approach.

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优化吡嗪酰胺的使用：改善结核性脑膜炎预后的一个容易实现的目标？叙述审查。

结核性脑膜炎（TBM）使超过三分之一的患者致残。最近的研究集中在优化抗结核方案，主要是通过增加利福平的剂量。然而，吡嗪酰胺对中枢神经系统的渗透性较高，通常被忽视。我们讨论了在TBM的整个抗结核治疗中使用吡嗪酰胺的潜在临床影响，而不是只在强化阶段。这种方法可以改善TBM的治疗效果并减少致残。我们从体外研究、临床队列、毒性数据和基线耐药率等方面总结了有关该方法的现有数据。此外，我们讨论了两个正在进行的临床试验评估这种方法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Infectious Diseases and Therapy Medicine-Microbiology (medical)

CiteScore

8.60

自引率

1.90%

发文量

136

审稿时长

6 weeks

期刊介绍： Infectious Diseases and Therapy is an international, open access, peer-reviewed, rapid publication journal dedicated to the publication of high-quality clinical (all phases), observational, real-world, and health outcomes research around the discovery, development, and use of infectious disease therapies and interventions, including vaccines and devices. Studies relating to diagnostic products and diagnosis, pharmacoeconomics, public health, epidemiology, quality of life, and patient care, management, and education are also encouraged. Areas of focus include, but are not limited to, bacterial and fungal infections, viral infections (including HIV/AIDS and hepatitis), parasitological diseases, tuberculosis and other mycobacterial diseases, vaccinations and other interventions, and drug-resistance, chronic infections, epidemiology and tropical, emergent, pediatric, dermal and sexually-transmitted diseases.