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Short-Course
Therapy with Rifampin plus Isoniazid, Compared with Standard Therapy
with Isoniazid, for Latent Tuberculosis Infection
A major difficulty associated with the use of standard therapy with isoniazid for latent
tuberculosis infection is poor patient adherence to therapy because of the prolonged course required. Shorter courses
of therapy involving 2 or more drugs have
been proposed as an alternative to standard therapy,
but they have not undergone enough testing.
Spanish researchers performed a meta-analysis
to determine the equivalence of daily short-course
therapy with rifampin plus isoniazid for 3 months and standard therapy
with isoniazid for 6-12 months. The end points
that were evaluated were development of active tuberculosis,
severe adverse drug reactions, and death.
The investigators searched published information in the Cochrane
Library, MEDLINE, and Embase databases, as well
as unpublished information in the Cambridge Scientific Abstracts Internet database, Conference Papers
Index, AIDS and Cancer Research Abstracts, and ClinicalTrials.gov.
They also scanned the reference lists of articles.
We only included trials in which individuals were
randomly allocated to receive treatment. Two reviewers independently applied the criteria for trial selection,
assessed trial quality, and extracted data.
Results
Five trials comprising
1926 adults from Hong Kong, Spain, and Uganda
were identified. The mean duration of follow-up
varied from 13 to 37 months. Overall, development
of active tuberculosis was equivalent in association
with both regimens.
Severe
adverse effects were reported
with a similar frequency for both regimens. However,
a subanalysis of high-quality trials (including 74% of the sample size) suggested that both regimens were equally safe.
In 3 trials
(comprising 1390 patients) that provided data on
mortality, the regimens showed
equivalence.
Conclusion
The authors conclude, “Short-course therapy
with rifampin plus isoniazid was equivalent to standard
therapy with isoniazid in terms of efficacy, the
proportion of severe side effects that occurred, and mortality.”
Internal Medicine Department, Marina Baixa Hospital, Villajoyosa, and Public Health Department, Universidad Miguel Hernandez, Alicante, Spain.
02/14/05
Reference
J Ena and V Valls.
Short-Course Therapy with Rifampin plus Isoniazid, Compared with Standard Therapy with Isoniazid, for Latent Tuberculosis Infection: A Meta-analysis. Clinical Infectious Diseases 40(5):
670-676. March 1, 2005.
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