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Isoniazid Preventive Therapy in Contacts of Multidrug-resistant Tuberculosis

Huang, C-C; Becerra, MC; Calderon, R; Contreras, C; Galea, J; Grandjean, L; Lecca, L; ... Murray, M; + view all (2020) Isoniazid Preventive Therapy in Contacts of Multidrug-resistant Tuberculosis. American Journal of Respiratory and Critical Care Medicine 10.1164/rccm.201908-1576OC. (In press). Green open access

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Abstract

RATIONALE: The World Health Organization recommends the use of isoniazid alone or in combination with rifapentine to treat latent tuberculosis infection. The recent rise of drug-resistant tuberculosis has complicated the choice of latent tuberculosis infection treatment regimen. OBJECTIVES: To evaluate the effects of isoniazid preventive therapy on contacts of multidrug-resistant tuberculosis patients Methods: In a prospective cohort study conducted between September 2009 and August 2012, we identified 4,500 index tuberculosis patients and 14,044 tuberculosis-exposed household contacts whom we followed for one year for the occurrence of incident tuberculosis disease. Although Peruvian national guidelines specify that isoniazid preventive therapy should be provided to contacts aged 19 and under, only half this group received isoniazid preventive therapy. MEASUREMENTS AND MAIN RESULTS: Among 4,216 contacts under 19 years of age, 2,106 (50%) initiated isoniazid preventive therapy at enrollment. The protective effect of isoniazid was more extreme in contacts exposed to drug-sensitive (adjusted hazard ratio, 0.30 [95% confidence interval, 0.18-0.48]) and to multidrug-resistant tuberculosis (0.19 [0.05-0.66]) compared to those exposed to mono-isoniazid-resistant (0.80 [0.23-2.80]). In the second independent study, tuberculosis occurred in none of the 76 household contacts who received isoniazid preventive therapy compared to 3% (8/273) of those who did not. CONCLUSION: Household contacts who received isoniazid preventive therapy had a lower incidence of tuberculosis disease even when they had been exposed to an index patient with multidrug-resistant tuberculosis. Isoniazid may have a role in the management of latent multidrug-resistant tuberculosis infection.

Type: Article
Title: Isoniazid Preventive Therapy in Contacts of Multidrug-resistant Tuberculosis
Location: United States
Open access status: An open access version is available from UCL Discovery
DOI: 10.1164/rccm.201908-1576OC
Publisher version: https://doi.org/10.1164/rccm.201908-1576OC
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: isoniazid, isoniazid preventive therapy, multidrug-resistant tuberculosis, tuberculosis
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health > Infection, Immunity and Inflammation Dept
URI: https://discovery.ucl.ac.uk/id/eprint/10103140
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