An old patient of tubercular meningitis is not responding to treatment. A new combination of drugs has to be prescribed for a prolonged period. Which one of the following should not be prescribed in this case –
**Core Concept**
Tubercular meningitis is a severe form of tuberculosis affecting the central nervous system, requiring a combination of antitubercular drugs for effective treatment. The choice of drugs is crucial to prevent resistance and ensure successful treatment.
**Why the Correct Answer is Right**
In tubercular meningitis, a combination of first-line antitubercular drugs such as isoniazid, rifampicin, pyrazinamide, and ethambutol is typically prescribed. However, in patients not responding to treatment, a new combination of drugs may be necessary. Among the options, **streptomycin** is an aminoglycoside antibiotic that is not suitable for long-term use in tubercular meningitis due to its potential for ototoxicity and nephrotoxicity. The other options are not inherently contraindicated in this scenario.
**Why Each Wrong Option is Incorrect**
**Option A:** Ethambutol is a first-line antitubercular drug that can be used in combination with other drugs for prolonged periods, making it a suitable option.
**Option B:** Pyrazinamide is another first-line antitubercular drug that can be used in combination for prolonged periods, making it a suitable option.
**Option C:** Isoniazid is a first-line antitubercular drug that can be used in combination with other drugs for prolonged periods, making it a suitable option.
**Clinical Pearl / High-Yield Fact**
When prescribing antitubercular drugs, it's essential to monitor for potential side effects, such as isoniazid-induced peripheral neuropathy, rifampicin-induced hepatotoxicity, and pyrazinamide-induced hyperuricemia.
**Correct Answer:** A. Streptomycin.