Details:

Alternative Title:
Clin Infect Dis
Personal Author:
Marks, Suzanne M. ; Mase, Sundari R. ; Morris, Sapna Bamrah
Marks, Suzanne M. ; Mase, Sundari R. ; Morris, Sapna Bamrah Less -
Description:
Background

Evidence-based recommendations for treating persons having presumed latent tuberculosis (LTBI) after contact to infectious multidrug-resistant (MDR) tuberculosis (TB) are lacking because published data consist of small observational studies. Tuberculosis incidence in persons treated for latent MDR -TB infection is unknown.

Methods

We conducted a systematic review of studies published 1 January 1994–31 December 2014 to analyze TB incidence, treatment completion and discontinuation, and cost-effectiveness. We considered contacts with LTBI effectively treated if they were on ≥1 medication to which their MDR-TB strain was likely susceptible. We selected studies that compared treatment vs nontreatment outcomes and performed a meta-analysis to estimate the relative risk of TB incidence and its 95% confidence interval.

Results

We abstracted data from 21 articles that met inclusion criteria. Six articles presented outcomes for contacts who were treated compared with those not treated for MDR-LTBI; 10 presented outcomes only for treated contacts, and 5 presented outcomes only for untreated contacts. The estimated MDR-TB incidence reduction was 90% (9%–99%) using data from 5 comparison studies. We also found high treatment discontinuation rates due to adverse effects in persons taking pyrazinamide-containing regimens. Cost-effectiveness was greatest using a fluoroquinolone/ethambutol combination regimen.

Conclusions

Few studies met inclusion criteria, therefore results should be cautiously interpreted. We found a reduced risk of TB incidence with treatment for MDR-LTBI, suggesting effectiveness in prevention of progression to MDR-TB, and confirmed cost-effectiveness. However, we found that pyrazinamide-containing MDR-LTBI regimens often resulted in treatment discontinuation due to adverse effects.


Subject:
[+]
Antitubercular Agents
Article
Contacts
Cost
Cost-Benefit Analysis
Disease Progression
Drug Resistance, Multiple, Bacterial
Ethambutol
Fluoroquinolones
Humans
Latent Tuberculosis
Multidrug-resistant
Pyrazinamide
Treatment
Treatment Outcome
Tuberculosis
Tuberculosis, Multidrug-Resistant

Source:
Clin Infect Dis. 64(12):1670-1677
Pubmed ID:
28329197
Pubmed Central ID:
PMC5543758
Document Type:
Journal Article
Funding:
CC999999/Intramural CDC HHS/United States
Collection(s):
CDC Public Access
Main Document Checksum:
[+]
urn:sha256:f5d6533782e7daf2b9df61652380c60118b956db5a765dfebb13ddbce0ff6e52
File Type:

Supporting Files

• 	NIHMS879075-supplement-appendix.pdf	pdf
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