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Background <p>The treatment of multidrug-resistant tuberculous meningitis (MDR-TBM) presents significant challenges, as the ability of different anti-tuberculosis (anti-TB) drugs to penetrate the blood-brain barrier varies greatly. The pharmacokinetic characteristics of second-line anti-TB drugs including bedaquiline, cycloserine, moxifloxacin and contezolid remains unclear, particularly in cerebrospinal fluid (CSF).</p> Case presentation <p>We report a case of a 30-year-old female who was diagnosed with MDR-TBM. Therapeutic drug monitoring (TDM) was used to determine whether each anti-TB drug’s peak concentration reached the effective range, and concentrations of each anti-TB drug in plasma and CSF of the patient after 5, 7, 9 and 12&#xa0;h of medication was detected, the CSF/plasma concentration ratio of each anti-TB drug was also analyzed.</p> Conclusions <p>TDM plays an important role in clinical individualized medication adjustment. Cycloserine, pyrazinamide, contezolid and moxifloxacin may have a high CSF permeability. This study provided valuable reference for the clinical management of MDR-TBM by measuring the plasma and CSF concentrations of anti-TB drugs.</p>

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Plasma and CSF pharmacokinetic characteristics of second-line anti-tuberculosis drugs in a patient with multidrug-resistant tuberculous meningitis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年11月21日

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  • Jinlong Gao,
  • Jie Cao,
  • Jinmeng Li,
  • Xiaohong Pan,
  • Huijie Wang,
  • Xinjun Cai,
  • Yuanyuan Chen

摘要

Background

The treatment of multidrug-resistant tuberculous meningitis (MDR-TBM) presents significant challenges, as the ability of different anti-tuberculosis (anti-TB) drugs to penetrate the blood-brain barrier varies greatly. The pharmacokinetic characteristics of second-line anti-TB drugs including bedaquiline, cycloserine, moxifloxacin and contezolid remains unclear, particularly in cerebrospinal fluid (CSF).

Case presentation

We report a case of a 30-year-old female who was diagnosed with MDR-TBM. Therapeutic drug monitoring (TDM) was used to determine whether each anti-TB drug’s peak concentration reached the effective range, and concentrations of each anti-TB drug in plasma and CSF of the patient after 5, 7, 9 and 12 h of medication was detected, the CSF/plasma concentration ratio of each anti-TB drug was also analyzed.

Conclusions

TDM plays an important role in clinical individualized medication adjustment. Cycloserine, pyrazinamide, contezolid and moxifloxacin may have a high CSF permeability. This study provided valuable reference for the clinical management of MDR-TBM by measuring the plasma and CSF concentrations of anti-TB drugs.