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

Zhilin Liang; Weiming Liao; Qifu Chen; Hui Li; Meiling Ye; Jin Zou; Guofang Deng; Peize Zhang

doi:10.2147/IDR.S401281

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

Infect Drug Resist. 2023 Mar 23:16:1669-1676. doi: 10.2147/IDR.S401281. eCollection 2023.

Authors

Zhilin Liang^#¹, Weiming Liao^#², Qifu Chen³, Hui Li¹, Meiling Ye¹, Jin Zou⁴, Guofang Deng¹, Peize Zhang¹

Affiliations

¹ Department of Pulmonary Medicine & Tuberculosis, The Third People's Hospital of Shenzhen, National Clinical Research Center for Infectious Disease, Southern University of Science and Technology, Shenzhen, People's Republic of China.
² Department of Thoracic Oncology, Jiangxi Provincial Cancer Hospital, Nanchang, People's Republic of China.
³ Department of Neurosurgery, The Third People's Hospital of Shenzhen, National Clinical Research Center for Infectious Disease, Southern University of Science and Technology, Shenzhen, People's Republic of China.
⁴ Department of Clinical Laboratory, The Third People's Hospital of Shenzhen, National Clinical Research Center for Infectious Disease, Southern University of Science and Technology, Shenzhen, People's Republic of China.

^# Contributed equally.

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: drug concentration; long-tunneled external ventricular drain; pharmacokinetics; pre-extensive drug resistant TB; tuberculous meningitis.

Publication types

Case Reports

Grants and 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.