Basic and Clinical Sciences (BCSE) Practice Exam

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Which drug is preferred for better CNS penetration in treating TB meningitis in children?

  1. Rifampicin

  2. Ethionamide

  3. Streptomycin

  4. Pyrazinamide

The correct answer is: Ethionamide

Ethionamide is recognized for its favorable central nervous system (CNS) penetration, making it an effective choice for treating tuberculosis (TB) meningitis, especially in children. TB meningitis is a severe form of tuberculosis that affects the membranes covering the brain and spinal cord, necessitating the use of medications that can cross the blood-brain barrier effectively. Ethionamide, being a structural analog of isoniazid, has been shown to penetrate into the CNS, which is crucial for treating infections like TB meningitis. This penetration allows it to exert its antimycobacterial effects directly where the infection is established in the CNS. Rifampicin is also known for good CNS penetration but is primarily utilized for its potent bactericidal activity against Mycobacterium tuberculosis rather than as a first-line choice in specific CNS infections. Streptomycin typically does not penetrate the CNS well and is generally not used for TB meningitis. Pyrazinamide, while it does achieve some CNS penetration, is mainly an adjunct in TB therapy and not the preferred choice for targeted treatment of CNS infections. Thus, the preference for ethionamide is due to its effective CNS penetration and suitability in managing TB meningitis in pediatric patients.