Shorter Antibiotics Course Is Effective In Treating Latent TB

Latent tuberculosis (TB) infection can be safely and effectively treated with 6-month isoniazid monotherapy, rifampicin monotherapy, and combination therapies with 3 to 4 months of isoniazid and rifampicin, according to a recent updated network meta-analysis.

It is estimated that 2 billion people worldwide have latent TB, and most will not develop active TB. However, treatment of latent TB infection is an important part of TB control.
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For their updated analysis, the researchers reviewed studies found in PubMed, Embase, and Web of Science Databases until May 8, 2017. Studies included in the analysis were randomized controlled trials that assessed treatments for human latent TB infection and recorded at least 1 of 2 prespecified outcomes of hepatotoxicity and prevention of active TB.

Data from eligible studies was extracted by 2 investigators, and study quality was evaluated in accordance with a standard protocol.

Ultimately, the update included 8 new studies, in addition to 53 that had been included previously. Treatments that were deemed efficacious compared with placebo were isoniazid regimens for 6 months or for 12 to 72 months, rifampicin-only regimens, rifampicin-isoniazid-pyrazinamide regimens, and rifampicin-pyrazinamide regimens.

Evidence also existed for the efficacy of weekly rifapentine-isoniazid regimens, vs no treatment. No conclusive evidence indicated that HIV status altered the efficacy of treatment.

“Evidence exists for the efficacy and safety of 6-month isoniazid monotherapy, rifampicin monotherapy, and combination therapies with 3 to 4 months of isoniazid and rifampicin,” the researchers concluded.

—Christina Vogt

Reference:

Zenner D, Beer N, Harris RJ, Lipman MC, Stagg HR, van der Werf MJ. Treatment of latent tuberculosis infection: an updated network meta-analysis [Published online August 1, 2017]. Ann Intern Med. doi:10.7326/M17-0609.