Pharmacokinetics of Antituberculosis Drugs in Plasma and Cerebrospinal Fluid in a Patient with Pre-Extensive Drug Resistant Tuberculosis Meningitis

Abstract

Drug-resistant tuberculous meningitis (TBM) is the most devastating and critical form of extrapulmonary tuberculosis. Here, we present a case of a 45-year-old male with pre-extensive drug-resistant tuberculosis meningitis (pre-XDR-TBM). He underwent emergency surgery for the long-tunneled external ventricular drainage (LTEVD). Molecular test and phenotypic drug sensitivity test (DST) of Mycobacterium tuberculosis in cerebrospinal fluid (CSF) showed that the isolate was resistant to both rifampin and fluoroquinolones. An anti-tuberculous regimen of isoniazid, pyrazinamide, cycloserine, moxifloxacin, clofazimine, and linezolid was tailored accordingly. We monitored the drug concentration in his plasma and CSF before (at 0-hour) and after anti-TB drugs administration (at 1-hour, 2-hour, 6-hour, and 12-hour) on 10^th day after treatment initiation. We hope to provide reference values of drug exposures in plasma and CSF for patients with pre-XDR-TBM.

Keywords:

• pre-extensive drug resistant TB
• tuberculous meningitis
• pharmacokinetics
• long-tunneled external ventricular drain
• drug concentration

Ethics Approval and Consent to Participate

Written informed consent for publication of this report was obtained from the patient and his wife. Institutional research board of The Third People’s Hospital of Shenzhen approved the publication of this case.

Acknowledgments

We greatly appreciate our patient and his family for their trust and kind cooperation.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

This work was supported by Summit Plan for Foshan High level Hospital Construction (No. FSSYKF-2020001), the Guangdong Provincial Clinical Research Center for Tuberculosis Project (No. 2020B1111170014) and Project of Shenzhen Third People’s Hospital (No. G2021023, No. G2021022) which are government fund for tuberculosis treatment and control.