2025/12/17
A higher dose of the antibiotic rifampicin does not improve the survival chances of patients with tuberculous meningitis. This serious form of tuberculosis causes meningitis, which kills half of the patients. These results come from a large international study partly set up and implemented by Radboud university medical centre. The research has now been published in the scientific journal New England Journal of Medicine.
Every year, 11 million people worldwide contract tuberculosis, which kills approximately 1.4 million people. meningitis occurs in 1 to 2% of patients. this is the most serious complication of tuberculosis, occurring when the tuberculosis bacteria enter the brain. Despite antibiotics, about half of patients with tuberculous meningitis die or are left with permanent damage such as deafness or paralysis.
Hospital pharmacist, clinical pharmacologist and professor Rob Aarnoutse says: ‘Previous studies showed that very little of the most important antibiotic against tuberculosis, rifampicin, reaches the brain. As a result, the tuberculosis bacteria are not properly cleared there. Though, those studies also revealed a link between a higher dose and reduced mortality.This prompted research from myself and many international researchers.’
Higher Dose of Antibiotic
Various studies have been initiated worldwide to investigate the effects of a higher dose of rifampicin. The first of these studies, co-established by Radboud university medical center and conducted in Indonesia, Uganda, and South Africa, examined whether a high dose of rifampicin could improve survival rates.
499 adults with tuberculous meningitis received the standard treatment of four different types of antibiotics (isoniazid, rifampicin, pyrazinamide, and ethambutol). Half of the participants also received a higher dose of rifampicin.The study found no meaningful difference in mortality rates between the two groups.
Aarnoutse explains: ‘This means that increasing the dose of rifampicin does not offer additional benefit for these patients. It is important to focus on other strategies to improve treatment, such as ensuring that patients can take their medication properly and identifying and treating the disease early.’
The study also investigated whether the higher dose of rifampicin had more side effects. It turned out that the higher dose was associated with more liver problems. this is another reason not to increase the dose of rifampicin.
Source: Radboud University medical Center
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