Isoniazid Preventive Therapy in Contacts of Multidrug-Resistant Tuberculosis
Document Type
Article
Publication Date
2020
Keywords
tuberculosis, multidrug-resistant tuberculosis, INH, INH preventive therapy
Digital Object Identifier (DOI)
https://doi.org/10.1164/rccm.201908-1576OC
Abstract
Rationale: The World Health Organization recommends the use of isoniazid (INH) alone or in combination with rifapentine to treat latent tuberculosis infections. The recent rise of drug-resistant tuberculosis has complicated the choice of treatment regimen for latent tuberculosis infection.
Objectives: To evaluate the effects of INH preventive therapy on the contacts of patients with multidrug-resistant tuberculosis.
Methods: In a prospective cohort study conducted between September 2009 and August 2012, we identified 4,500 index patients with tuberculosis and 14,044 tuberculosis-exposed household contacts who we followed for 1 year for the occurrence of incident tuberculosis disease. Although Peruvian national guidelines specify that INH preventive therapy should be provided to contacts aged 19 years old or younger, only half this group received INH preventive therapy.
Measurements and Main Results: Among 4,216 contacts under 19 years of age, 2,106 contacts (50%) initiated INH preventive therapy at enrollment. The protective effect of INH was more extreme in contacts exposed to drug-sensitive tuberculosis (adjusted hazard ratio, 0.30; 95% confidence interval, 0.18–0.48) and to multidrug-resistant tuberculosis (adjusted hazard ratio, 0.19; 95% confidence interval, 0.05–0.66) compared with those exposed to mono–INH-resistant tuberculosis (adjusted hazard ratio, 0.80; 95% confidence interval, 0.23–2.80). In the second independent study, tuberculosis occurred in none of the 76 household contacts who received INH preventive therapy compared with 3% (8 of 273) of those who did not.
Conclusions: Household contacts who received INH preventive therapy had a lower incidence of tuberculosis disease even when they had been exposed to an index patient with multidrug-resistant tuberculosis. INH may have a role in the management of latent multidrug-resistant tuberculosis infection.
Was this content written or created while at USF?
Yes
Citation / Publisher Attribution
American Journal of Respiratory and Critical Care Medicine, v. 202, issue 8, p. 1159-1168
Scholar Commons Citation
Huang, Chuan-Chin; Becerra, Mercedes C.; Calderon, Roger; Contreras, Carmen; Galea, Jerome; Grandjean, Louis; Lecca, Leonid; Yataco, Rosa; Zhang, Zibiao; and Murray, Megan, "Isoniazid Preventive Therapy in Contacts of Multidrug-Resistant Tuberculosis" (2020). Social Work Faculty Publications. 186.
https://digitalcommons.usf.edu/sok_facpub/186
