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Completion Rate and Safety of Tuberculosis Infection Treatment With Shorter Regimens.
Pediatrics. 2018 02; 141(2)Ped

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.

Authors+Show Affiliations

Department of Pediatrics, Baylor College of Medicine, Houston, Texas acruz@bcm.edu.Department of Pediatrics, Baylor College of Medicine, Houston, Texas.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

29363561

Citation

Cruz, Andrea T., and Jeffrey R. Starke. "Completion Rate and Safety of Tuberculosis Infection Treatment With Shorter Regimens." Pediatrics, vol. 141, no. 2, 2018.
Cruz AT, Starke JR. Completion Rate and Safety of Tuberculosis Infection Treatment With Shorter Regimens. Pediatrics. 2018;141(2).
Cruz, A. T., & Starke, J. R. (2018). Completion Rate and Safety of Tuberculosis Infection Treatment With Shorter Regimens. Pediatrics, 141(2). https://doi.org/10.1542/peds.2017-2838
Cruz AT, Starke JR. Completion Rate and Safety of Tuberculosis Infection Treatment With Shorter Regimens. Pediatrics. 2018;141(2) PubMed PMID: 29363561.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Completion Rate and Safety of Tuberculosis Infection Treatment With Shorter Regimens. AU - Cruz,Andrea T, AU - Starke,Jeffrey R, PY - 2017/11/08/accepted PY - 2018/1/25/pubmed PY - 2019/1/17/medline PY - 2018/1/25/entrez JF - Pediatrics JO - Pediatrics VL - 141 IS - 2 N2 - 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. SN - 1098-4275 UR - https://www.unboundmedicine.com/medline/citation/29363561/Completion_Rate_and_Safety_of_Tuberculosis_Infection_Treatment_With_Shorter_Regimens_ L2 - http://pediatrics.aappublications.org/cgi/pmidlookup?view=long&amp;pmid=29363561 DB - PRIME DP - Unbound Medicine ER -