isoniazid + rifampicin + pyrazinamide + levofloxacin + ethambutol

This combination antimicrobial regimen consists of four first-line anti-tuberculosis agents (isoniazid, rifampicin, pyrazinamide, and ethambutol) and a second-line fluoroquinolone (levofloxacin). It is primarily investigated and used for the treatment of tuberculous meningitis (TBM), particularly in pediatric populations, to improve clinical outcomes and overcome potential drug resistance. The regimen works through multiple synergistic mechanisms: isoniazid inhibits mycolic acid synthesis; rifampicin inhibits bacterial RNA polymerase; pyrazinamide disrupts membrane potential and fatty acid synthesis; ethambutol inhibits cell wall arabinosyltransferase; and levofloxacin inhibits DNA gyrase and topoisomerase IV. Kunming Children's Hospital has been a key developer and investigator of this intensified regimen, conducting clinical trials to evaluate its efficacy in reducing mortality and neurological sequelae in children with TBM.

Other names

HRZEL regimen