Tuberculosis prevention in Mexican immigrants: limitations of short-course therapy.
BACKGROUND
Two months of rifampin and pyrazinamide (RIF/PZA) for tuberculosis prevention has been advocated as a way to improve adherence in mobile populations, such as recent immigrants. However, RIF/PZA requires intensive patient and laboratory monitoring for hepatotoxicity.


OBJECTIVE
To describe the feasibility and outcomes of using RIF/PZA for TB prevention during a tuberculosis outbreak in a Mexican immigrant community, where 23 adults and 11 children were treated with RIF/PZA between August 2001 and October 2001.


METHODS
Retrospective chart review and interviews with health department employees were conducted to assess completion rates, hepatotoxicity, cost, and feasibility of monitoring.


RESULTS
Ten (91%) children and 13 (57%) adults completed RIF/PZA. One child (9%) and four adults (17%) developed drug-induced hepatitis. Cultural barriers affected care. The adults resisted the biweekly blood draw, believing it would "drain them of energy." RIF/PZA, plus monitoring, was twice as costly as 4 months of rifampin.


CONCLUSIONS
RIF/PZA was associated with significant hepatotoxicity, poor completion, and cultural barriers to monitoring, and was more costly than standard therapy. Tuberculosis prevention must address potential clinical, cultural, and economic barriers to completion and monitoring of short-course therapy in immigrants.
Kandula
Namratha R
NR
Robert Wood Johnson Clinical Scholars Program, University of Chicago, Chicago, Illinois 60637, USA. nkandula@medicine.bsd.uchicago.edu
Dworkin
Mark S
MS
Carroll
Margaret R
MR
Lauderdale
Diane S
DS
D000293:Adolescent; D000328:Adult; D000904:Antibiotics, Antitubercular / Q000009:adverse effects* / Q000191:economics / Q000627:therapeutic use; D056486:Chemical and Drug Induced Liver Injury / Q000208:ethnology / Q000209:etiology*; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks / Q000517:prevention & control; D004359:Drug Therapy, Combination; D004641:Emigration and Immigration; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D017058:Mexican Americans / Q000523:psychology* / Q000706:statistics & numerical data; D008800:Mexico / Q000208:ethnology; D008875:Middle Aged; D010349:Patient Compliance / Q000208:ethnology*; D011718:Pyrazinamide / Q000009:adverse effects* / Q000191:economics / Q000627:therapeutic use; D012293:Rifampin / Q000009:adverse effects* / Q000191:economics / Q000627:therapeutic use; D014376:Tuberculosis / Q000188:drug therapy* / Q000208:ethnology / Q000517:prevention & control*; D014481:United States
D000904:Antibiotics, Antitubercular; D011718:Pyrazinamide; D012293:Rifampin