Investigators from Denver Health and Hospital Authority and the University of Colorado School of Medicine, Aurora, CO, compared medication completion rates in children with latent tuberculosis (TB) infection (LTBI) treated with either a 9-month regimen of isoniazid (9H) or a 4-month regimen of rifampin (4R). Study participants were patients <18 years old with a diagnosis of LTBI at the Denver Metro Tuberculosis Clinic (DMTBC) between 2006 and 2015. The investigators reviewed medical records of study children and abstracted data on demographic characteristics (including age, primary language, and birth country); clinical characteristics; and whether the patient completed the treatment regimen and, if not completed, the reasons for not completing. Diagnosis of LTBI was based on a positive tuberculin skin test (TST) or interferon gamma release assay (IGRA), symptom review, and chest radiographs. Before 2012, 9H was the preferred treatment regimen for children with LTBI treated at DMTBC; beginning in 2012, the preferred regimen was 4R. The primary study outcome was completion of treatment regimen. Logistic regression was used to assess differences in completion rates between regimens, after controlling for other variables, including contact with an active case, language spoken, common language (defined as spoken by >5% of all patients as a marker of better interpreter or language services), age, and global area of origin. Reasons for failure to complete 9H or 4R treatment, such as drug toxicity and personal or social barriers, were compared with chi-square tests.
Data were analyzed in 1,174 children: 779 treated with 9H, and 395 treated with 4R. Overall treatment completion rates were 83.5% for those receiving 4R and 68.8% for those receiving 9H. After the investigators controlled for confounding variables, treatment completion was significantly more likely for those in the 4R group (OR, 1.64; 95% CI, 1.07–2.52). Other variables significantly associated with completion of treatment regimen were contact with an active case (OR, 1.82; 95% CI, 1.13–2.93) and speaking a common language (OR, 1.58; 95% CI, 1.02–2.45). The most common reason for not completing the treatment regimen in both groups was personal or social barriers (moving out of clinic catchment area, being lost to follow-up, or patient or parent refusal to continue), occurring in 10.9% and 26.2% of those in the 4R and 9H groups, respectively (P<.001). Drug toxicity leading to discontinuation of the treatment regimen was reported in 1.5% of those receiving 4R and 0.8% of those receiving 9H (P=.23).
The authors conclude that children with LTBI treated with 4R were more likely to complete their treatment regimen than were those receiving 9H.
Dr Brady has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.
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