Safety of 2 months of rifampin and pyrazinamide for treatment of latent tuberculosis.
An alternative regimen for the treatment of latent tuberculosis infection is 2 months of rifampin and pyrazinamide, but some patients have died of hepatitis associated with this therapy. One hundred fourteen patients received rifampin/pyrazinamide in Wake County, North Carolina, between December 1999 and May 2002; 60.5% of these patients were homeless, and at least 17% drank alcohol to excess. Seventy-seven patients (67.5%) completed a full 2-month course. Nine patients had a history of viral hepatitis or chronic liver disease. Four of 114 (3.5%; 95% confidence interval, 1.0-8.7%) patients developed hepatitis on therapy, and another two had symptoms consistent with hepatitis but did not report for laboratory testing (total confirmed plus suspected hepatitis rate 5.3%; 95% confidence interval, 2.0-11.1%). No patient who developed hepatitis had a history of viral hepatitis or liver disease, and none had been previously treated with isoniazid. No patients died or were hospitalized due to drug side effects. Rifampin/pyrazinamide was associated with a significantly higher rate of hepatitis than previously described with isoniazid therapy for latent tuberculosis but resulted in a high completion rate. The rifampin/pyrazinamide regimen for latent tuberculosis infection may be useful for high-risk, traditionally nonadherent patient groups, but careful monitoring for toxicity is required.
Stout
Jason E
JE
Division of Infectious Diseases, Duke University Medical Center, Durham, NC 27710, USA. stout002@mc.duke.edu
Engemann
John J
JJ
Cheng
Allen C
AC
Fortenberry
Ellen R
ER
Hamilton
Carol D
CD
D000293:Adolescent; D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000150:complications; D000904:Antibiotics, Antitubercular / Q000009:adverse effects*; D000995:Antitubercular Agents / Q000009:adverse effects*; D056486:Chemical and Drug Induced Liver Injury / Q000175:diagnosis / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D015897:Comorbidity; D004334:Drug Administration Schedule; D016903:Drug Monitoring; D004359:Drug Therapy, Combination; D005260:Female; D006509:Hepatitis B / Q000150:complications; D006526:Hepatitis C / Q000150:complications; D006703:Ill-Housed Persons; D006801:Humans; D007223:Infant; D008107:Liver Diseases / Q000150:complications; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D011718:Pyrazinamide / Q000009:adverse effects*; D012293:Rifampin / Q000009:adverse effects*; D012449:Safety; D016896:Treatment Outcome; D014376:Tuberculosis / Q000188:drug therapy* / Q000209:etiology
D000904:Antibiotics, Antitubercular; D000995:Antitubercular Agents; D011718:Pyrazinamide; D012293:Rifampin