Intermittent or daily short course chemotherapy for tuberculosis in children: meta-analysis of randomized controlled trials.
OBJECTIVE
To compare the effectiveness of intermittent with daily chemotherapy (both containing rifampicin) in childhood tuberculosis (age 16yrs) in achieving cure significant improvement.


METHODS
Systematic Review and Meta-analysis.


METHODS
MEDLINE and the Cochrane Library were searched for randomized trials of antitubercular regimens containing rifampicin, in children 16 yrs or less with tuberculosis. Two reviewers independently assessed trial eligibility and quality. Data from full articles of selected studies were independently extracted by two authors and analyzed. The odds ratio was obtained for the pooled data in two groups (intermittent and daily therapy).


METHODS
Cure/significant improvement, relapse rate and adverse events.


RESULTS
Four randomized controlled trials comparing twice weekly and daily therapy including 466 children (pulmonary 439; extrapulmonary 27) met the inclusion criteria. Baseline data were comparable. On quality assessment, 3 studies scored 2 and one study scored 3 out of 5 points. Per protocol analysis showed that children receiving intermittent regimen were less likely to be cured than those receiving daily therapy (OR 0.27; 95% CI: 0.14, 0.51). The results of intention to treat analysis suggest similar trend towards lower cure rates with twice weekly regimen (OR 0.66; 95% CI: 0.23-1.84).


CONCLUSIONS
Twice weekly intermittent short course therapy is less likely to cure tuberculosis in children as compared to daily therapy. There is a need for better quality randomized controlled trials for assessing efficacy of alternate schedule for intermittent therapy for childhood tuberculosis.
Menon
P Ramesh
PR
Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
Lodha
R
R
Sivanandan
S
S
Kabra
S K
SK
D000904:Antibiotics, Antitubercular / Q000008:administration & dosage*; D002648:Child; D004334:Drug Administration Schedule; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D012293:Rifampin / Q000627:therapeutic use; D016896:Treatment Outcome; D014376:Tuberculosis / Q000188:drug therapy*
D000904:Antibiotics, Antitubercular; D012293:Rifampin