There is increasing interest in exploring alternative evidence-based
treatment regimens for TBM. RCT findings suggest a mortality
benefit from an ‘intensified’ treatment regimen early during TBM
treatment.[10] This study investigated the safety and pharmacokinetic
profiles of higher-than-normal dose, intravenous (IV) RIF and
oral moxifloxacin in HIV-infected and -uninfected TBM patients.
Although not powered to detect a mortality benefit, an improved
outcome was observed in patients receiving IV RIF (~13 mg/kg/d)
than in those on the oral standard dose during the initial 2 weeks of
TB treatment. Patients who received IV RIF had a reduced mortality
at 6-month follow-up (34%) compared with those who received oral
RIF (65%). A further RCT assessing the use of higher doses of oral
RIF (15 mg/kg/d) and oral levofloxacin in improving TBM outcome
is currently ongoing in Vietnam (ISRCTN61649292). Results of this trial,
which may lead to changes in treatment guidelines, are expected in 2015.