Ethionamide- and Ofloxacin-Based Antitubercular Therapy for the Treatment of Drug-Sensitive Central Nervous System Tuberculosis in Children

A bstract Background: Conventional first-line regimens for pediatric central nervous system tuberculosis (CNS-TB) have been associated with poor clinical outcomes. In view of their bactericidal effect and high penetration rates into the CNS, ethionamide and ofloxacin may improve treatment outcomes. Aims: To determine treatment outcomes of pediatric CNS-TB with ethionamide- and/or ofloxacin-containing first-line regimens. Setting and Design: A retrospective study was conducted at the Pediatric TB Clinic of a tertiary care children’s hospital in Mumbai, India, from March 2020 to August 2024. Materials and Methods: We included 88 children less than 18 years, diagnosed with drug-sensitive CNS-TB and treated with first-line regimens containing ethionamide and/or ofloxacin. Data on clinical and microbiological features, adverse effect profiles, and treatment outcomes were analyzed. Statistical Analysis: Percentages are used for expressing qualitative variables, and mean ± standard deviation, median, and range are used for expressing quantitative variables. Results: The mean age at presentation was 6.94 ± 4.48 years with a male:female ratio of 0.6:1. Seventeen (19.3%) patients had isolated TB meningitis (TBM), 18 (20.45%) had isolated tuberculomas, and 53 (60.23%) had both. Twenty-seven (38.57%), 22 (31.43%), and 21 (30%) patients had stages I, II, and III TBM, respectively. Neurological deficits developed in 31 (35.23%) patients during treatment, of which seven (7.95%) patients had residual deficits at treatment completion. At treatment completion, one (1.14%) patient had bilateral sensorineural hearing loss, two (2.27%) patients had bilateral optic atrophy, and four (4.55%) patients had motor and cranial nerve palsies. Conclusion: Ethionamide and/or ofloxacin-containing first-line regimens can achieve favorable neurological outcomes at the end of treatment and may be considered in the management of pediatric CNS-TB.