High-dose rifampin fails to cut tuberculous meningitis deaths, may worsen outcomes

News brief

High doses of the oral antibiotic rifampin did not improve survival outcomes in adults with tuberculous (TB) meningitis compared with standard therapy, finds a randomized controlled clinical trial published in the New England Journal of Medicine.

Meningitis is the most severe complication of TB, occurring when the bacteria reaches the brain. Despite antibiotic treatment, roughly half of TB meningitis patients die or incur severe, permanent damage. Previous research has shown that small amounts of rifampin, the most powerful antibiotic against TB, can reach the brain. But those studies did not explore the link between higher doses of rifampin and reduced mortality.

Mortality greater in high-dose group

For the study, led by researchers at Makerere University in Kampala, Uganda, 499 adults with confirmed TB meningitis in Indonesia, Uganda, and South Africa were assigned to receive either the standard treatment of four antibiotics (isoniazid, pyrazinamide, ethambutol, and 10 milligrams per kilogram [mg/kg] of rifampin) or the same regimen with a higher dose of rifampin (35 mg/kg).

After six months, the trial found no evidence that higher-dose rifampin improved survival. In fact, mortality was greater in the higher-dose group (44.6%) than in the standard-dose group (40.7%).

“It was, of course, disappointing that this is not the solution,” study coauthor Reinout van Crevel, MD, PhD, of the University of Oxford, said in a press release. “But these are important results—we now know we need to take a different path. That’s how science works.”

It’s unclear why the higher-dose rifampin group had worse outcomes, but one hypothesis is that the stronger dose may lead to a dysregulated immune response. Follow-up studies are underway to investigate why high-dose rifampin had no benefit.

Therapies that better control the inflammatory response of TB meningitis are urgently needed, say the researchers. Van Crevel will focus future research on tumor necrosis factor (TNF) inhibitors, a type of medication that blocks inflammation.

“These drugs are sometimes used later in treatment of tuberculous meningitis when corticosteroids fail. But no one has used TNF inhibitors at the start of treatment—when most patients die,” he said. “That’s what we will investigate in the next clinical trial.”

Utah confirms 20 new measles infections as US cases in 2025 top 2,100

News brief

Stephanie Soucheray, MA

measles in child — Mike Blyth / Wikimedia Commons

Officials have confirmed 20 more measles cases in Utah, raising the state total to 176, and the Centers for Disease Control and Prevention (CDC) released nationwide totals for 2025, noting 2,144 confirmed cases

Of the 176 infections in Utah, 129 (73%) are in the Southwest Utah health district, which has seen high measles activity alongside neighboring Mohave County, Arizona.

In other hot spot news, three North Carolina siblings who had recently visited Upstate South Carolina now have measles infections, according to an update from the North Carolina Department of Health and Human Services.

“The family had visited Spartanburg County, South Carolina, where there is a large ongoing measles outbreak approximately 1-2 weeks before the children became sick,” North Carolina officials said.

South Carolina has reported 211 cases associated with an outbreak in the Upstate region.

79 new US infections

In the first weekly measles update of the year, the CDC confirmed three measles infections in the United States in 2026 as of January 6, with cases noted only in North and South Carolina and none of them travel related.

The 2,144 confirmed US measles cases for all of 2025 reflect an increase of 79 infections. Eighty-eight percent of those cases were part of 49 outbreaks. For comparison, 16 outbreaks were reported during 2024, and 69% of cases (198 of 285) were outbreak-associated, the CDC said. The 2025 total is the most since 1992, when officials recorded 2,200 cases.

Study: Non-prescription antibiotic prescribing common in retail medicine settings in sub-Saharan Africa

News brief

Chris Dall, MA

Pharmacy in Togo, Africa — Africanway / iStock

More than two-thirds of retail medicine outlets in sub-Saharan Africa (SSA) regularly dispense antibiotics without a prescription, according to a study published today in JAC-Antimicrobial Resistance.

To evaluate current antimicrobial stewardship (AMS) practices in regulated retail medicine settings, which include community pharmacies, accredited drug dispensing outlets (ADDOs), and patient proprietary medicine vendors (PPMVs), British and Nigerian researchers conducted a review and meta-analysis of 26 studies examining the types of AMS interventions that are available in those settings, the factors that facilitate or hinder the implementation of such interventions, and the level of knowledge about antimicrobial resistance (AMR) and AMS activities among regulated retail medicine staff. They also analyzed data on antibiotic dispensing practices.

"The success of AMS programmes led by community pharmacists in LMICs [low- and middle-income countries] including SSA, is hindered by factors like limited AMR and AMS knowledge, time constraints, and inadequate resources," the study authors wrote. "Therefore, this study aimed to analyse existing studies to examine the knowledge, practices and challenges in delivering AMS interventions in regulated retail medicine settings across SSA."

68% of retail medicine outlets dispense antibiotics without a prescription

While the review found that community pharmacists generally have an awareness of the role that inappropriate antibiotic use plays in AMR, knowledge gaps among ADDO and PPMV staff, who have limited formal training, were more pronounced. Few studies documented AMS activities that have been implemented in these settings. Furthermore, in the 10 studies with extractable numeric data, the reported prevalence of non-prescription antibiotic dispensing ranged from 9% to 97%, with a median prevalence of 67.5%.

Community pharmacies and medicine vendors reported dispensing antibiotics on demand for common self-limiting illnesses, including respiratory infections, diarrhea, and urinary tract infections. Non-prescription antibiotic prescribing was driven by patient demand, economic motives, and weak regulatory enforcement, the researchers found.

The authors say the findings reveal a "concerning disconnect" between knowledge of appropriate antibiotic use and actual dispensing behaviors, along with substantial barriers to proper AMS in these settings.

"Our findings also suggest that while foundational knowledge exists, transforming awareness into consistent best practices requires addressing systemic educational and resource barriers in community pharmacy settings," they wrote.