Use of Intermittent Rifampin and Pyrazinamide Therapy for Latent Tuberculosis Infection in a Targeted Tuberculin Testing Program

Priest, David H.; Vossel, Louis F.; Sherfy, Elizabeth A.; Hoy, Debbie P.; Haley, Connie A.

doi:10.1086/425610

Cited by 33 publications

(11 citation statements)

References 27 publications

(46 reference statements)

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“…Previous studies have found inconsistent associations between adherence to LTBI treatment and these factors. 8–10 Also, while the study by Reichler, et al found that recent TST converters were most likely to complete LTBI treatment, 6 this was not a significant factor associated with treatment completion in the current study. Interestingly, study sites differed significantly in treatment completion.…”

Section: Discussioncontrasting

confidence: 57%

Risk factors for treatment default in close contacts with latent tuberculous infection

Fiske¹,

Yan²,

Hirsch‐Moverman³

et al. 2014

int j tuberc lung dis

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Objective To characterize risk factors for non-completion of treatment for latent tuberculosis infection (LTBI). Secondarily, to assess the impact of LTBI treatment regimen on subsequent risk of tuberculosis. Methods Close contacts of adults (≥15 years) with pulmonary tuberculosis were prospectively enrolled in a multi-center study in the U.S. and Canada from January 2002–December 2006. Close contacts to TB patients were screened and cross-matched with tuberculosis registries to identify those who developed active tuberculosis. Results Of the 3,238 contacts screened, 1,714 (53%) were diagnosed with LTBI. Preventive therapy was recommended in 1,371 (80%); 1,147 contacts (84%) initiated therapy, of whom 723 (63%) completed treatment. In multivariate analysis, study site, initial interview sites other than a home or healthcare setting, and treatment with isoniazid were significantly associated with LTBI treatment non-completion. Fourteen tuberculosis cases were identified in contacts, all of whom initiated isoniazid. There were two cases among persons who received six or more months of isoniazid (66 cases/100,000 person-years), and nine cases among persons who received 0–5 months (median 2 months) of isoniazid (792 cases/100,000 person-years; p<0.001); data on duration of isoniazid for three cases were not available. Conclusion Only 53% (723 of 1,371) of close contacts for whom preventive therapy was recommended actually completed treatment. Close contacts of TB patients were significantly less likely to complete LTBI treatment if they took isoniazid. Less than six months of isoniazid therapy was associated with increased risk of active TB.

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Section: Discussioncontrasting

confidence: 57%

Risk factors for treatment default in close contacts with latent tuberculous infection

Fiske¹,

Yan²,

Hirsch‐Moverman³

et al. 2014

int j tuberc lung dis

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“…1993; Donald 2010). Further, a study including 423 immigrants found PZA‐associated hepatotoxicity to be correlated with age: the odds of hepatotoxicity rising by 1.07 times per year of age increase (Priest et al. 2004), and a study investigating PT found drug‐associated hepatitis increased significantly with age, from <1% in those aged 0–19 years to 5% in those aged 60 years or more (Ormerod & Horsfield 1996).…”

Section: Overcoming the Barriersmentioning

confidence: 99%

Preventive therapy in children exposed to Mycobacterium tuberculosis: problems and solutions

Rutherford¹,

Hill²,

Triasih³

et al. 2012

Tropical Med Int Health

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Young children living with a tuberculosis patient are at high risk of Mycobacterium tuberculosis infection and disease. WHO guidelines promote active screening and isoniazid (INH) preventive therapy (PT) for such children under 5 years, yet this well-established intervention is seldom used in endemic countries. We review the literature regarding barriers to implementation of PT and find that they are multifactorial, including difficulties in screening, poor adherence, fear of increasing INH resistance and poor acceptability among primary caregivers and healthcare workers. These barriers are largely resolvable, and proposed solutions such as the adoption of symptom-based screening and shorter drug regimens are discussed. Integrated multicomponent and site-specific solutions need to be developed and evaluated within a public health framework to overcome the policy-practice gap and provide functional PT programmes for children in endemic settings.

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“…10,34 The recommendation of daily rifampin and pyrazinamide for 2 months was discontinued 34 after it was shown to have unacceptable liver toxicity. 35 The CDC has issued no clear recommendation on how long latent TB infection prophylaxis must be given before a TNF-a inhibitor may be added, but it is preferable for a patient to receive the full 9-month course of therapy. However, the patient's clinical course may require earlier initiation of therapy, and the clinician must balance the possible increased risk of active TB with the morbidity suffered from protracted disease.…”

Section: Treatment Of Latent Tb Infectionmentioning

confidence: 99%

National Psoriasis Foundation consensus statement on screening for latent tuberculosis infection in patients with psoriasis treated with systemic and biologic agents

Doherty

Voorhees

Lebwohl

et al. 2008

Journal of the American Academy of Dermatology

153

133

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Use of Intermittent Rifampin and Pyrazinamide Therapy for Latent Tuberculosis Infection in a Targeted Tuberculin Testing Program

Abstract: Despite the use of DOPT, intermittent dosing, and vigilant monitoring throughout therapy, RZ was associated with an unacceptable risk of hepatotoxicity.

Cited by 33 publications

References 27 publications

Risk factors for treatment default in close contacts with latent tuberculous infection

Risk factors for treatment default in close contacts with latent tuberculous infection

Preventive therapy in children exposed to Mycobacterium tuberculosis: problems and solutions

National Psoriasis Foundation consensus statement on screening for latent tuberculosis infection in patients with psoriasis treated with systemic and biologic agents

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