Effectiveness and safety of the schedules of short and long term treatment for tuberculous meningoencephalitis at two hospitals of Lima - Peru

Abstract

Introduction

To compare the effectiveness and safety of short-term 6 month-treatment and long term 12 month-treatment schedules for meningoencephalitis due to tuberculosis in two hospitals from Lima-Peru.

Methods

Comparative, retrospective and observational study. The patients were divided in two groups: Group 1: long term 12 month-treatment with isoniazid, rifampin, pyrazinamide, and ethambutol for the first 2 months; then isoniazid and rifampin for 10 months. Group 2: short-term 6 month-treatment with isoniazid and rifampin, pyrazinamide and ethambutol for the first 2 months; then isoniazid and rifampin for 4 months. Clinical records, effectiveness, treatment failure, treatment side effects, mortality and late consequences after treatment were reviewed.

Results

Twenty-six patients with meningoencephalitis level I were included, 10 received the long term schedule and 16 the short-term schedule treatment. From 51 patients with meningoencephalitis level II, 27 received the long term schedule and 24 the short-term schedule treatment and of 31 patients with meningoencephalitis level III, 18 received the long term schedule treatment and 13 the short-term schedule treatment. There was no statistically significant differences among levels I, II and III when effectiveness of short and long term schedule was evaluated. Moreover, there was no statistically significant difference in the frequency of treatment failure, treatment side effects, mortality and late consequences among groups.

Conclusions

Long term 12 month-treatment and short-term 6 month-treatment had similar effectiveness and safety in the treatment of meningoenchephalitis due to tuberculosis in HIV negative patients.bility in work protocols and rationalises the use of the available health care resources.

Resumen

Introducción

Comparar la efectividad y seguridad de los esquemas corto de 6 meses y largo de 12 meses en el tratamiento de la meningoencefalitis tuberculosa de pacientes VIH negativos de dos hospitales de Lima-Perú.

Métodos

Estudio comparativo, retrospectivo y observacional. Los pacientes recibieron uno de los siguientes esquemas de tratamiento: grupo 1, curso largo de 12 meses de tratamiento con isoniazida, rifampicina, pirazinamida y etambutol los primeros 2 meses; luego isoniazida y rifampicina durante 10 meses. Grupo 2, curso corto de 6 meses con isoniazida, rifampicina, pirazinamida y etambutol los primeros 2 meses; luego isoniazida y rifampicina durante 4 meses. Se revisó las historias clínicas y se evaluó en ambos grupos la efectividad, recaídas, fracaso terapéutico, reacciones adversas a fármacos antituberculosos, mortalidad y secuelas luego de concluir tratamiento.

Resultados

Se presentaron 26 pacientes con meningoencefalitis grado I, de los cuales 10 recibieron el esquema de tratamiento largo y 16 el esquema corto; 51 con meningoencefalitis grado II, 27 recibieron el esquema largo y 24 el esquema corto; y 31 con meningoencefalitis grado III, recibiendo 18 el esquema largo y 13 el esquema corto. Al evaluarse la efectividad de los esquemas corto y largo no se encontró diferencia estadísticamente significativa en los grados I, II y III; tampoco existió diferencia estadísticamente significativa en la frecuencia de recaídas, fracaso terapéutico, reacciones adversas a fármacos antituberculosos, en la mortalidad y secuelas.

Conclusiones

Los esquemas largo de 12 meses y corto de 6 meses tendrían similar efectividad y seguridad en el tratamiento de la meningoencefalitis tuberculosa de pacientes VIH negativos