Boosting Pyrazinamide: Could It Be a Game-Changer for Tuberculous Meningitis?

Tuberculous meningitis (TBM) leaves more than a third of its victims with serious disabilities. While a lot of recent focus has been on adjusting the dosage of rifampicin, another drug, pyrazinamide, is often ignored. Pyrazinamide has the advantage of better penetration into the central nervous system, which makes it a promising candidate for improving TBM treatment outcomes. Currently, pyrazinamide is usually only used during the intensive phase of TBM treatment. However, some experts believe that using it throughout the entire treatment period could lead to better outcomes and less disability. This approach is based on various data, including lab studies, clinical observations, toxicity reports, and baseline resistance rates. Two clinical trials are currently underway to test this theory. They aim to provide concrete evidence on whether continuous use of pyrazinamide really makes a difference in treating TBM.