title: Short-course isoniazid plus rifapentine directly observed therapy for latent tuberculosis in solid-organ transplant candidates.
abstract: BACKGROUND
  Short-course directly observed isoniazid plus rifapentine (INH/RPT) combination could have potential advantages over a standard 9-month INH regimen for the treatment of latent tuberculosis infection in solid-organ transplant (SOT) candidates.
  
  
  METHODS
  We prospectively assessed the safety and tolerability of 12 weeks of INH/RPT given directly observed therapy in 17 consecutive SOT candidates with latent tuberculosis infection.
  
  
  RESULTS
  The median age was 57 years and 82% were men. Of the 17 patients, 13 (76%) successfully completed therapy and 4 (24%) eventually underwent SOT. Treatment was prematurely discontinued in four patients. One of these patients underwent a kidney transplant. The overall dose compliance was 83% (169/204 scheduled doses), and 12 (71%) of 17 patients received 100% of scheduled doses. No patient developed transaminase elevations greater than twice baseline or greater than four times the upper limit of normal or clinical hepatotoxicity. No cases of TB developed during 20.4 months after transplant among INH/RPT-treated recipients.
  
  
  CONCLUSIONS
  For carefully selected SOT candidates, combination INH/RPT weekly given as directly observed therapy seems to be reasonably well tolerated and is associated with a relatively high completion rate. Future larger prospective studies to confirm the safety and high completion rates reported here and to identify the most appropriate SOT candidates for this regimen are warranted.
authors.affiliation: 1 Solid-Organ Transplant Infectious Disease Program, Division of Allergy and Infectious Disease, Department of Medicine, University of Washington, Seattle, WA. 2 TB Control Program, Public Health - Seattle & King County, WA. 3 Division of Pulmonary & Critical Care, Department of Medicine, University of Washington, Seattle, WA. 4 School of Pharmacy, University of Washington, Seattle, WA. 5 Address correspondence to: Ajit P. Limaye, M.D., University of Washington, Box 356174, 1959 NE Pacific St, Seattle, WA 98195-6174.
authors.forename: Diego López
authors.initials: DL
authors.lastname: de Castilla
authors.forename: Robert M
authors.initials: RM
authors.lastname: Rakita
authors.forename: Christopher E
authors.initials: CE
authors.lastname: Spitters
authors.forename: Masahiro
authors.initials: M
authors.lastname: Narita
authors.forename: Rupali
authors.initials: R
authors.lastname: Jain
authors.forename: Ajit P
authors.initials: AP
authors.lastname: Limaye
mesh_terms: D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000008:administration & dosage*; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology; D023801:Directly Observed Therapy; D005260:Female; D006801:Humans; D007538:Isoniazid / Q000008:administration & dosage* / Q000009:adverse effects; D055985:Latent Tuberculosis / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation; D011446:Prospective Studies; D012293:Rifampin / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*
chemical_list: D000995:Antitubercular Agents; D007538:Isoniazid; D012293:Rifampin; C018421:rifapentine