Current treatment options for latent tuberculosis infection.
Treatment of latent tuberculosis infection (LTBI) is a key component in TB control strategies worldwide. However, as people with LTBI are neither symptomatic nor contagious, any screening decision should be weighed carefully against the potential benefit of preventing active disease in those who are known to be at higher risk and are willing to accept therapy for LTBI. This means that a targeted approach is desirable to maximize cost effectiveness and to guarantee patient adherence. We focus on LTBI treatment strategies in patient populations at increased risk of developing active TB, including candidates for treatment with tumor necrosis factor-α blockers. In the last 40 years, isoniazid (INH) has represented the keystone of LTBI therapy across the world. Although INH remains the first therapeutic option, alternative treatments that are effective and associated with increased adherence and economic savings are available. Current recommendations, toxicity, compliance, and cost issues are discussed in detail in this review. A balanced relationship between the patient and healthcare provider could increase adherence, while cost-saving treatment strategies with higher effectiveness, fewer side effects, and of shorter duration should be offered as preferred.
Address correspondence to Dr. Bocchino, Università degli Studi di Napoli Federico II, Divisione di Malattie dell'Apparato Respiratorio, Azienda dei Colli (Ospedale Monaldi), Via L. Bianchi 5, 80131 Naples, Italy. E-mail: marialuisa.bocchino@unina.it.
Marialuisa
M
Bocchino
Alessandro
A
Matarese
Alessandro
A
Sanduzzi
D000995:Antitubercular Agents / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D006801:Humans; D007538:Isoniazid / Q000191:economics / Q000627:therapeutic use*; D055985:Latent Tuberculosis / Q000188:drug therapy* / Q000191:economics; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
D000995:Antitubercular Agents; D014409:Tumor Necrosis Factor-alpha; D007538:Isoniazid
LATENT TUBERCULOSIS INFECTION; TREATMENT; TUMOR NECROSIS FACTOR-α BLOCKERS