Andrea T Cruz1, Jeffrey R Starke2. 1. Department of Pediatrics, Baylor College of Medicine, Houston, Texas acruz@bcm.edu. 2. Department of Pediatrics, Baylor College of Medicine, Houston, Texas.
Abstract
BACKGROUND: The traditional treatment of tuberculosis (TB) infection (9 months of daily isoniazid [9H]) is safe but completion rates of <50% are reported. Shorter regimens (3 months of once-weekly isoniazid and rifapentine [3HP] or 4 months of daily rifampin [4R]) are associated with improved adherence in adults. METHODS: This was a retrospective cohort study (2014-2017) of children (0-18 years old) seen at a children's TB clinic in a low-incidence nation. We compared the frequency of completion and adverse events (AEs) in children receiving 3HP, 4R, and 9H; the latter 2 regimens could be administered by families (termed self-administered therapy [SAT]) or as directly observed preventive therapy (DOPT); 3HP was always administered under DOPT. RESULTS: 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 SAT completed therapy. Children receiving 3HP were more likely to complete therapy than the 9H (SAT) group (odds ratio [OR] 27.4, 95% confidence interval [CI]: 11.8-63.7). Multivariate analyses found receipt of medication under DOPT (OR: 5.72, 95% CI: 3.47-9.43), increasing age (OR: 1.09, 95% CI: 1.02-1.17), and the absence of any AE (OR: 1.70, 95% CI: 0.26-0.60) to be associated with completing therapy. AEs were more common in the 9H group (OR: 2.51, 95% CI: 1.48-4.32). Two (0.9%) children receiving 9H developed hepatotoxicity; no child receiving 3HP or 4R developed hepatotoxicity. CONCLUSIONS: Shorter regimens are associated with increased completion rates and fewer AEs than 9H.
BACKGROUND: The traditional treatment of tuberculosis (TB) infection (9 months of daily isoniazid [9H]) is safe but completion rates of <50% are reported. Shorter regimens (3 months of once-weekly isoniazid and rifapentine [3HP] or 4 months of daily rifampin [4R]) are associated with improved adherence in adults. METHODS: This was a retrospective cohort study (2014-2017) of children (0-18 years old) seen at a children's TB clinic in a low-incidence nation. We compared the frequency of completion and adverse events (AEs) in children receiving 3HP, 4R, and 9H; the latter 2 regimens could be administered by families (termed self-administered therapy [SAT]) or as directly observed preventive therapy (DOPT); 3HP was always administered under DOPT. RESULTS: 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 SAT completed therapy. Children receiving 3HP were more likely to complete therapy than the 9H (SAT) group (odds ratio [OR] 27.4, 95% confidence interval [CI]: 11.8-63.7). Multivariate analyses found receipt of medication under DOPT (OR: 5.72, 95% CI: 3.47-9.43), increasing age (OR: 1.09, 95% CI: 1.02-1.17), and the absence of any AE (OR: 1.70, 95% CI: 0.26-0.60) to be associated with completing therapy. AEs were more common in the 9H group (OR: 2.51, 95% CI: 1.48-4.32). Two (0.9%) children receiving 9H developed hepatotoxicity; no child receiving 3HP or 4R developed hepatotoxicity. CONCLUSIONS: Shorter regimens are associated with increased completion rates and fewer AEs than 9H.
Authors: Courtney M Yuen; Ana K Millones; Jerome T Galea; Daniela Puma; Judith Jimenez; Leonid Lecca; Mercedes C Becerra; Salmaan Keshavjee Journal: BMC Public Health Date: 2021-01-11 Impact factor: 3.295
Authors: Anca Vasiliu; Sabrina Eymard-Duvernay; Boris Tchounga; Daniel Atwine; Elisabete de Carvalho; Sayouba Ouedraogo; Michael Kakinda; Patrice Tchendjou; Stavia Turyahabwe; Albert Kuate Kuate; Georges Tiendrebeogo; Peter J Dodd; Stephen M Graham; Jennifer Cohn; Martina Casenghi; Maryline Bonnet Journal: Trials Date: 2021-03-02 Impact factor: 2.279
Authors: Kathryn J Snow; Andrea T Cruz; James A Seddon; Rashida A Ferrand; Silvia S Chiang; Jennifer A Hughes; Beate Kampmann; Steve M Graham; Peter J Dodd; Rein M Houben; Justin T Denholm; Susan M Sawyer; Katharina Kranzer Journal: Lancet Child Adolesc Health Date: 2019-11-18