Choice of preventive treatment for isoniazid-resistant tuberculous infection. Use of decision analysis and the Delphi technique.
Proper care of persons infected with isoniazid-resistant tubercle bacilli is controversial because there are few data on the risks and benefits of the preventive treatment alternatives. Decision analysis was used to facilitate a comparison of outcomes using different strategies and the Delphi technique to obtain estimates of relevant probabilities. For all probabilities of isoniazid resistance, the observation and no-drug alternative is unsatisfactory because it sould result in a twofold to sevenfold greater number of tuberculosis cases than any of the drug regimens. With a low probability of isoniazid resistance, isoniazid is the preventive treatment of least cost and proved efficacy. As the probability of isoniazid resistance increases, more cases are prevented by rifampin-containing regimens, but at added cost. These findings can be used to formulate appropriate preventive treatment recommendations.
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D003657:Decision Making; D003697:Delphi Technique; D004352:Drug Resistance, Microbial; D004358:Drug Therapy / Q000191:economics; D004359:Drug Therapy, Combination; D006801:Humans; D007223:Infant; D007538:Isoniazid / Q000008:administration & dosage / Q000494:pharmacology*; D009169:Mycobacterium tuberculosis / Q000187:drug effects*; D012293:Rifampin / Q000008:administration & dosage; D011795:Surveys and Questionnaires; D014376:Tuberculosis / Q000517:prevention & control*
D007538:Isoniazid; D012293:Rifampin