Clinical Edge

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Are Shorter Regimens of TB Infection Tx Safe?

Pediatrics; ePub 2018 Jan 23; Cruz, et al

Shorter regimens for tuberculosis infection (TB) treatment of children are associated with increased completion rates and fewer adverse events than the traditional treatment of 9 months of daily isoniazid (9H), a recent study found. The retrospective cohort study included children aged 0 to 18 years from 2014 to 2017 and compared the frequency of completion and adverse events in children receiving 3 months of once-weekly isoniazid and rifapentine (3HP), 4 months of daily rifampin (4R), and 9H. Among the details:

  • TB infection treatment was started in 667 children: 283 (42.4%) 3HP, 252 (37.8%) 9H, and 132 (19.8%) 4R.
  • Only 52% of children receiving 9H via self-administered therapy (SAT) completed therapy.
  • The highest completion rates were seen with 3HP (96.8%) and the lowest with 9H under SAT (52.6%)
  • Adverse events were more common in the 9H group.

Citation:

Cruz AT, Starke JR. Completion rate and safety of tuberculosis infection treatment with shorter regimens. [Published online ahead of print January 23, 2018]. Pediatrics. doi:10.1542/peds.2017-2838.

Commentary:

It is difficult to take medicine, especially when you feel well and the medications are for prevention of future morbidity. Standard therapy for the treatment of latent TB is a 9-month regimen of isoniazid. Even though the 9-month regimen is effective at decreasing the likelihood of developing active TB, this study and others show only about 50% of people complete a 9-month regimen of INH. As former Surgeon General C. Everett Koop once said, “Medicines don’t work in people who don’t take them.” The study above shows that a 3-month regimen of once-weekly isoniazid and rifapentine has much higher rate of completion. — Neil Skolnik, MD

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