Tuberculous Meningitis Occurring During Isoniazid Therapy

Abstract

The authors describe a patient who developed tuberculous meningitis while receiving isoniazid in a dosage of 9 mg/kg/day. The child when first seen had miliary tuberculosis. She was treated at this time with isoniazid and streptomycin. The streptomycin was discontinued after 13 weeks, when the patient was discharged to receive isoniazid in a dosage of 9 mg/kg/day. Four months later, the child developed signs and symptoms of tuberculous meningitis. It was well-documented that the patient had been receiving the medication regularly. The child was then treated with isoniazid in a dosage of 14 mg/kg/day which was increased to 22 mg/kg/day, and in addition, streptomycin and p-aminosalicylic acid were given. Reversal of the tuberculous process occurred after this therapy, and the patient was well 1 year later. From a review of the literature, and their experience with this patient, the authors conclude that isoniazid should be given in dosages of 15 to 30 mg/kg/day in treatment of children with active disseminated tuberculosis. They also recommend that 50 mg of pyridoxine be given each day to prevent toxicity from the isoniazid.