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Only 3-month course safe, effective and patient compliant in latent Tuberculosis

Only 3-month course safe, effective and patient compliant in latent Tuberculosis

Short course regimen of 3-month isoniazid-rifapentine can be administered by directly observed therapy(DOT) for latent tuberculosis infection(LTBI) treatments, recommends The Centers for Disease Control and Prevention. Isoniazid, also known as isonicotinylhydrazide (INH), is an antibiotic used for the treatment of tuberculosis.

Gibril J. Njie and his associates did a systematic review and meta-analysis to examine the most recent evidence regarding 3-month isoniazid-rifapentine’s effectiveness, safety, and treatment completion. in preventing active TB among adults, adolescents, children aged 2 or more years as well as treatment completion rates for participants administered the regimen by DOT or self-administered therapy (SAT) when directly compared with other LTBI treatments—mostly 9 months of INH.

The reviewers identified, evaluated, and summarized a total of 292 articles published during January 2006–June 2017  using Community Guide methodology.

INH and rifapentine are administered together as a combination regimen for treating LTBI. The regimen is taken once weekly under DOT or SAT for 12 weeks

The team hypothesized that use of 3HP, either administered by DOT or SAT, to treat LTBI among people aged ≥12 years, children aged 2–11 years, and People Living with HIV/AIDS (PLWHA) would lead to increased treatment completion rates, and thus reduce TB-related morbidity and mortality. Additionally, administration of 3HP by SAT could lead to reduced costs and resources for public health programs, and administration by DOT could lead to an increased patient-provider interaction because of weekly patient visits, which could potentially enhance reporting of adverse events. The team also postulated that key effect modifiers (e.g., tobacco use, low body weight, diabetes, and HIV treatment) could have a negative impact on the overall effectiveness of 3HP in preventing TB disease, as well as treatment completion.

The study found that 3HP is effective for TB prevention. However, the review did not find the 3HP regimen to be statistically more effective than other LTBI regimens. According to the review, 3HP improves treatment completion rates, compared with other LTBI treatment regimens. 3HP treatment completion is slightly lower under SAT than DOT, but completion with 3HP-SAT still remains high, compared with other LTBI treatments.

The study concluded that the 3-month isoniazid-rifapentine regimen is as safe and effective as other recommended latent tuberculosis infection regimens and achieves significantly higher treatment completion rates.

Tuberculosis (TB) is one of the leading causes of death from infectious diseases in the world. Globally, approximately 1.7 billion people are estimated to be infected with Mycobacterium tuberculosis, the causative agent of TB among humans. Treatment of latent tuberculosis infection (LTBI) in people at high risk for progression to active TB is a principal strategy for controlling and eliminating TB. For individuals with LTBI, isoniazid (INH) treatment for 6–12 months has been reported to reduce the risk for progression to active TB disease by 60%–90%. However, because of the long treatment duration, lack of patient tolerability, and risk for hepatotoxicity, its effectiveness in preventing TB disease has been hindered by inadequate acceptance and low treatment completion rates.

The article was published in the American Journal of Preventive Medicine.

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Source: With inputs from American Journal of Preventive Medicine

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    Dr C indira devi June 22, 2018, 9:58 pm

    Great approach-add on Lansoprazole (ppi+ATT action) needs trial DOT for latent TB-Dr indira Rtd Addl Director of med edu AP INDIA