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October 1986

Pyrazinamide in Treatment of Tuberculous Meningitis

Author Affiliations

Department of Neurology Neurosciences Centre All India Institute of Medical Sciences New Delhi-110029, India

Arch Neurol. 1986;43(10):982. doi:10.1001/archneur.1986.00520100008005

To the Editor.  —We describe herein our preliminary, uncontrolled observation on the use of pyrazinamide for tuberculous meningitis (TBM), in 40 adults, treated in the years 1983 to 1985. The efficacy and relative non-toxicity of the drug should be emphasized; ever since its inception into the armamentarium of antituberculous drugs, it has been relegated to the place of second-line drugs. Despite the most efficient crossing of the blood-brain barrier by pyrazinamide,1 it was used sparingly in TBM, possibly for fear of hepatotoxicity. There are still concerns about hepatotoxicity,2 but experience from a larger number of cases, including ours, has proved this risk to be rare.3 Only recently, with more lucid understanding about mechanisms of actions of antitubercular drugs, coupled with extensive trials on short-term chemotherapy, has pyrazinamide been accepted as one of the most important first-line drugs.4 In one therapeutic trial from India,5 which involved

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