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Short-course TB treatment improves completion rates in paediatric patients

10 Feb 2018

The use of shorter treatment regimens in children with tuberculosis (TB) infection leads to increased rates of completion and fewer adverse events (AEs) when compared with 9 months of daily isoniazid (9H) treatment, a study has shown.

Researchers reviewed the medical records of 667 children with TB infection (median age 8 years; 50.8 percent female) who received 9H (n=252), 4 months of daily rifampin (4R; n=132) or 3 months of once-weekly isoniazid and rifapentine (3HP; n=283).

The 4R and 9H regimens could be administered by families (self-administered therapy [SAT]) or as directly observed preventive therapy (DOPT). On the other hand, 3HP was always administered under DOPT.

Completion rates were highest with 3HP (96.8 percent) and lowest with 9H under SAT (52.6 percent; odds ratio [OR], 27.4; 95 percent CI, 11.8–63.7). When administered under DOPT, 9H had a completion rate of 89 percent (vs 9H under SAT: OR, 7.11; 3.54–14.28). The rates did not significantly differ between 3HP and 4R under DOPT (OR, 1.12; 0.14–9.09).

On multivariable regression analysis, completion of therapy was associated with the following factors: receipt of medication under DOPT (OR, 5.72; 3.47–9.43), increasing age (OR, 1.09; 1.02–1.17) and the absence of any AE (OR, 1.70; 0.26–0.60).

There were 62 children (9.3 percent) overall with complaints of any AE, which occurred frequently in the 9H group (OR, 2.51; 1.48–4.32). Hepatotoxicity was reported in two (0.9 percent) children in the 9H group in none in the 3HP and 4R groups.

The present data indicate that the 3HP and 4R regimens are well tolerated and associated with significantly higher completion rates compared with 9H, with the effectiveness of these short-course regimens being high in the short-term, researchers said.

“We hope that the coming years will see a shift in TB infection diagnosis to IGRAs to enable treatment to target the children who would receive the most benefit from therapy, and that increased data on 3HP pharmacokinetics and more child-friendly formulations of 3HP will enable this shorter regimen to be used in the most vulnerable paediatric population: infants and young children,” they added.

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Most Read Articles
Jairia Dela Cruz, 20 Jan 2018
Empagliflozin appears to be beneficial to type 2 diabetes (T2D) patients with established cardiovascular disease (CVD) and chronic kidney disease (CKD), yielding reductions in CV and all-cause mortality, as well as in heart failure and all-cause hospitalization compared with placebo, according to a study.
13 Feb 2018
Short-term treatment with methotrexate at >0.5 defined daily dose (8.75 mg/week) may help reduce the risk of ischaemic stroke in rheumatoid arthritis (RA) patients, while hydroxychloroquine and sulfasalazine have neutral effects, a retrospective study has found.
28 Dec 2017
Varenicline, while effective for smoking cessation, appears to significantly elevate the risk of cardiovascular hospitalization and emergency department visits, particularly for new users, a recent study shows.
29 Nov 2017
Younger children appear to be more likely to experience behavioural side effects of antiepileptic drugs (AEDs), with the likelihood increasing if children with epilepsy have baseline hyperactivity/impulsivity, a retrospective study has found.