PEDIATRICS Vol. 20 No. 4 October 1957, pp. 676-687
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THE RELATIVE MERITS OF ISONIAZID AND OTHER THERAPEUTIC AGENTS IN THE TREATMENT OF TUBERCULOUS MENINGITIS IN CHILDREN

A Five-year Follow-up

Bret Ratner M.D.1, George R. Klimkiewicz M.D.1, William C. Ellis M.D.1, H. John Malone M.D.1, and Joseph Dolgin M.D.1

1 Pediatric Service, Sea View Hospital, Staten Island, New York and the Department of Pediatrics, New York Medical College

Isoniazid (Rimifon®) given alone from the inception of tuberculous meningitis effected a complete cure in two patients.

Isoniazid given as the sole therapeutic agent effected a cure in 11 patients with tuberculous meningitis who had failed to recover with streptomycin alone or in combination with other antituberculous drugs.

Two infants recovered completely from miliary tuberculosis during administration of isoniazid from the inception of the disease. Because such infants usually develop tuberculous meningitis, we might consider that they had incipient meningitis which was aborted.

Five patients developed severe sequelae while receiving streptomycin for tuberculous meningitis. They were then given isoniazid alone and showed no further sequelae nor did meningitis recur.

Three patients died who received streptomycin followed by isoniazid alone.

Of the 21 patients the survival rate was 86%. The survival rate of the 13 patients with bacteriologically proved tuberculous meningitis was 77%. The eight cases not bacteriologically proved are discussed.

From our experience, it seems reasonable to conclude that isoniazid administered alone in the treatment of tuberculous meningitis does not produce neurologic residua. The neurologic sequelae produced by streptomycin, such as deafness, hydrocephalus or mental vegetation, once established, cannot always be corrected by isoniazid. However, one child who was becoming blind while receiving streptomycin, recovered sight completely after administration of isoniazid alone.

The high survival rate of 77% in the 13 patients with bacteriologically proved tuberculous meningitis treated with isoniazid alone from the inception of the disease, or after treatment with streptomycin, gives evidence for the remarkable therapeutic effects of isoniazid.

The modes of action of isoniazid and streptomycin are compared and their relative merits as therapeutic agents are discussed. Whether isoniazid should be used alone or in combination with other drugs are questions for further study.

Submitted on November 29, 1956
Accepted on April 30, 1957