title: Antibiotic prophylaxis for preventing post solid organ transplant tuberculosis.
abstract: BACKGROUND
  Organ transplant recipients are at increased risk of infection as a result of immunosuppression caused inadvertently by medical treatment. Tuberculosis (TB) is a challenging infection to manage among organ transplant recipients that can be transmitted from infected people or triggered from latent infection. Organ transplant recipients have been reported to be up to 300 times more likely to develop TB than the general population. Consensus about the use of antibiotic prophylaxis to prevent post solid organ transplant TB has not been achieved.
  
  
  OBJECTIVE
  This review assessed the benefits and harms of antibiotic prophylaxis to prevent post solid organ transplant TB.
  
  
  METHODS
  We searched the Cochrane Renal Group's Specialised Register up to 30 April 2013 through contact with the Trials' Search Co-ordinator using search terms relevant to this review. Studies contained in the Specialised Register are identified through search strategies specifically designed for CENTRAL, MEDLINE and EMBASE and handsearching conference proceedings.
  
  
  METHODS
  All randomised controlled trials (RCTs) and quasi-RCTs that compared antibiotic prophylaxis with a placebo or no intervention for recipients of solid organ transplants were included.
  
  
  METHODS
  Two authors independently assessed studies for inclusion and extracted data. We derived risk ratios (RR) for dichotomous data and mean differences (MD) for continuous data with 95% confidence intervals (CI). Methodological risk of bias was assessed using the Cochrane risk of bias tool.
  
  
  RESULTS
  We identified three studies (10 reports) that involved 558 kidney transplant recipients which met our inclusion criteria. All studies were conducted in countries that have high prevalence of TB (India and Pakistan), and investigated isoniazid, an oral antibacterial drug. Control in all studies was no antibiotic prophylaxis. Prophylactic administration of isoniazid reduced the risk of developing TB post-transplant (3 studies, RR 0.35 95% CI 0.14 to 0.89), and there was no significant effect on all-cause mortality (2 studies, RR 1.39, 95% CI 0.70 to 2.78). There was however substantial risk of liver damage (3 studies, RR 2.74, 95% CI 1.22 to 6.17).Reporting of methodological quality parameters was incomplete in all three studies. Overall, risk of bias was assessed as suboptimal.
  
  
  CONCLUSIONS
  Isoniazid prophylaxis for kidney transplant recipients reduced the risk of developing TB post-transplant. Kidney transplant recipients in settings that have high prevalence of TB should receive isoniazid during the first year following transplant. There is however, significant risk of liver damage, particularly among those who are hepatitis B or C positive. Further studies are needed among recipients of other solid organ transplants and in settings with low prevalence of TB to determine the benefits and harms of anti-TB prophylaxis in those populations.
authors.affiliation: Department of Medicine, Aminu Kano Teaching Hospital, No 1 Hospital Road, Kano, Kano, Nigeria, PMB 3452.
authors.forename: Bappa
authors.initials: B
authors.lastname: Adamu
authors.forename: Aliyu
authors.initials: A
authors.lastname: Abdu
authors.forename: Abdullahi A
authors.initials: AA
authors.lastname: Abba
authors.forename: Musa M
authors.initials: MM
authors.lastname: Borodo
authors.forename: Imad M
authors.initials: IM
authors.lastname: Tleyjeh
mesh_terms: D019072:Antibiotic Prophylaxis / Q000009:adverse effects / Q000379:methods*; D000995:Antitubercular Agents / Q000009:adverse effects / Q000627:therapeutic use*; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology; D006509:Hepatitis B / Q000150:complications; D006526:Hepatitis C / Q000150:complications; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D007538:Isoniazid / Q000009:adverse effects / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000009:adverse effects*; D014376:Tuberculosis / Q000517:prevention & control*
chemical_list: D000995:Antitubercular Agents; D007538:Isoniazid