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1 August 2006

Volume 43, Number 3
Clinical Infectious Diseases 2006;43:271–275
© 2006 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2006/4303-0001$15.00
DOI: 10.1086/505398
MAJOR ARTICLE

Safety and Completion Rate of Short‐Course Therapy for Treatment of Latent Tuberculosis Infection

Paul P. Cook,1

Ricardo A. Maldonado,1

Connie T. Yarnell,3 and

Don Holbert2

1Brody School of Medicine and 2Department of Biostatistics, East Carolina University, and 3Pitt County Health Department, Greenville, North Carolina

Background.Nine months of isoniazid therapy is the recommended regimen for treatment of latent tuberculosis infection, but low completion rates are a serious problem. The search for shorter regimens, compared with the standard isoniazid regimen, is of vital importance. We describe our experience using short‐course regimens for the treatment of latent tuberculosis infection.

Methods.We conducted a nonrandomized, observational study of 459 patients in a county health department from June 2000 to January 2006. Short‐course therapy was defined as pyrazinamide and rifampin taken daily or twice weekly for 2 months or rifampin taken daily for 4–6 months. Conventional therapy consisted of a 9‐month regimen of isoniazid. Liver function testing was performed for both groups in accordance with clinical guidelines. Treatment completion and hepatotoxicity (according to the World Health Organization classification) were determined for the short‐course and conventional therapy groups.

Results.Treatment was completed by 241 (77.7%) of 310 patients in the short‐course group and by 98 (65.8%) of 149 patients in the isoniazid group ( ). Moderate to severe hepatotoxicity (grades 3 and 4) occurred in 6.1% of patients receiving short‐course therapy and in 2.0% of patients receiving isoniazid ( ). The hepatotoxicity observed in the short‐course group was confined to patients receiving pyrazinamide and rifampin daily and was self limited in all cases after the medications were discontinued.

Conclusions.The rate of treatment completion was significantly higher with short‐course regimens, compared with the isoniazid regimen. Although the overall risk of hepatotoxicity in patients receiving pyrazinamide and rifampin daily for the treatment of latent tuberculosis infection was higher, liver functions returned to normal after the medications were discontinued.

Received 3 February 2006; accepted 17 April 2006; electronically published 22 June 2006.

Reprints or correspondence: Dr. Paul Cook, Brody School of Medicine, East Carolina University, Doctors Park 6A, Greenville, NC 27834 ().

Cited by

Heather Young, Mireya Wessolossky, Jeanne Ellis, Martin Kaminski, and Jennifer S. Daly. (2009) A Retrospective Evaluation of Completion Rates, Total Cost, and Adverse Effects for Treatment of Latent Tuberculosis Infection in a Public Health Clinic in Central Massachusetts. Clinical Infectious Diseases 49:3, 424-427
Online publication date: 1-Aug-2009.
Abstract-Full Text-PDF Version (236 kB)
Cherinne Arundel, James H Lewis. (2007) Drug-induced liver disease in 2006. Current Opinion in Gastroenterology 23:3, 244???254
Online publication date: 1-Jun-2007.
CrossRef
Paul P. Cook. (2007) Reply to Ijaz et al.. Clinical Infectious Diseases 44:3, 465-465
Online publication date: 1-Feb-2007.
Citation-Full Text-PDF Version (214 kB)
Kashef Ijaz, Peter D. McElroy, John Jereb, Thomas R. Navin, and Kenneth G. Castro. (2007) Safety of the Rifampin and Pyrazinamide Short‐Course Regimen for Treating Latent Tuberculosis Infection. Clinical Infectious Diseases 44:3, 464-465
Online publication date: 1-Feb-2007.
Citation-Full Text-PDF Version (214 kB)
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