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

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). 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. 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.