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G334(P) Early Outcome of Directly Observed Treatment, Short Course (DOTS) strategy for Childhood Tuberculous Meningitis: Analysis from a Tertiary Centre in India
  1. P Dewan1,
  2. TK Chadha1,
  3. IR Kaur2,
  4. P Gupta1
  1. 1Pediatrics, University College of Medical Sciences, Delhi, India
  2. 2Microbiology, University College of Medical Sciences, Delhi, India

Abstract

Aim We evaluated the early outcome of intermittent Directly Observed Therapy – Short course (DOTS), for children admitted with tuberculous meningitis (TBM) treated under the National TB Control Program in Delhi, India.

Methods Participants: 30 children with TBM. Those with pre-existing neurological disorders and mental retardation were excluded. Design: Prospective observational. Setting: Inpatients, tertiary hospital. Intervention: Diagnosis was based on clinical features, characteristic CSF and neuroimaging findings, and supportive evidence of tuberculosis (contact, abnormal chest radiograph, and positive tuberculin test). Participants received anti-tuberculous drugs thrice a week (2H3R3Z3E3 + 7H3R3) in addition to supportive therapy. Outcome variables: Mortality and neurological morbidity within 8 weeks of starting anti-tuberculous therapy.

Results We evaluated 30 children with TBM aged 10 months to 12 years. At the end of 8 weeks of treatment, the overall mortality was 40% (12/30). All children who expired had Stage 3 TBM at admission. Of the survivors (n = 18), 9 (50%) had significant neurological morbidity (spasticity 2, cranial neuropathy 6, visual deficit 4, motor deficit 7). A significant correlation existed between mortality and lack of BCG vaccination (r = 0.6, p < 0.001), younger age (r = 0.39, p = 0.03), stunting (r = 0.44, p = 0.014), wasting (r = 0.52, p = 0.004) and increasing severity of the disease (r = 0.53, p = 0.001).

Conclusion Intermittent short course directly observed therapy (DOTS) for children with tuberculous meningitis is associated with a high early mortality and significant neurological morbidity after 8 weeks of therapy under program conditions in India. There is a need to compare it with regimes of daily therapy.

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