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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
Audrey Abella, 15 May 2020
In adults with atrial fibrillation (AF) after percutaneous coronary intervention (PCI), dual therapy (direct oral anticoagulant [DOAC] + P2Y12 inhibitor) reduces the risk of bleeding compared with triple therapy (vitamin K antagonist [VKA] + DAPT* [aspirin and P2Y12 inhibitor]), a meta-analysis has shown. However, its effects on the risks of mortality and ischaemic endpoints** remain unclear.
09 May 2020
Use of aspirin during the implantation window of the menstrual cycle appears to increase fecundability, reveals a recent study.
Rachel Soon, 08 Apr 2020

Guidelines for local pharmacists on what actions to take during the COVID-19 pandemic have been issued by the Malaysian Pharmaceutical Society (MPS).

Pearl Toh, 11 Jun 2019
The novel antibody-drug conjugate enfortumab vedotin showed promising clinical activity in patients with advanced and metastatic urothelial cancer for whom there is a high unmet need, according to the EV-201 study presented at the ASCO 2019 Meeting.