‘Treatment of latent tuberculosis with the shorter therapy of Rifampin is safer and more effective in children and adults than the standard therapy of Isoniazid.’
infection or LTBI is a dormant version of the disease that does not cause
symptoms but one that could lead to the serious illness if treatment is not
Dr. Dick Menzies and his team from RI-MUHC led the
study in which they followed 850 children and 6,800 adults with LTBI.
The patients originated from nine different
countries across five continents - Australia, Benin, Brazil, Canada, Ghana,
Guinea, Indonesia, Saudi Arabia and South Korea.
The team compared two treatment regimens - the
current standard nine-month treatment with isoniazid
(INH) versus a four-month treatment
Rifampin Showed Better
- Researchers found that over 85 percent of children (and around the
same percent in adults) completed the rifampin regimen without developing
active TB, compared to a lesser percentage of children (76 percent) in the
isoniazid regimen where two of them developed active TB.
- Children and adults accepted and completed the rifampin therapy
with significantly fewer serious side effects, particularly drug induced hepatitis (INH is capable of
causing serious liver toxicity which can prove fatal or require a liver
- The rates at which active TB set in were slightly lower with
rifampin, which along with its shorter treatment schedule indicates that
it is at least as effective as the nine-month treatment of INH in
"This four-month therapy is a fundamental
game-changer in TB prevention," says Dr. Menzies, who is a respirologist
with the MUHC and a professor of Medicine, Epidemiology and Biostatistics at
McGill University. "The four month treatment was as effective in
preventing TB, safer and more acceptable. We believe this four month rifampin
treatment should replace the nine months on INH for most people who need
therapy for latent TB."
Dr. Menzies has also acted as an advisor to the
Public Health Agency of Canada, Citizenship and Immigration Canada, the Centers
for Disease Control (CDC) and the World Health Organization (WHO) on TB. He
expects that these new findings will fuel a fresh look at global practices and
will have a substantial impact on TB and its treatment, especially considering
the diverse group of participants in the study.
(TB) is an infectious disease that mostly affects the lungs
. The bacterium that causes the disease, Mycobacterium
can also damage other parts of the body.
The mode of
transmission of TB is primarily through the air
spreads from one person to another when a person with TB of the lungs or throat
coughs, sneezes, or talks. Symptoms include a bad cough that lasts 3 weeks or
longer, weight loss, loss of appetite, weakness, and fever.
Not everyone who gets infected with the TB bacteria
becomes sick or has symptoms. As a result, there are two TB-related conditions:
latent TB infection (LTBI) and TB disease
If a person has LTBI, they cannot pass TB germs to
other people but will need to stay on medicines for 3, 6, or 9 months, so they
do not get TB disease. If a person has TB disease, they will need to take TB
for at least 6 months; it takes at least 2 to 3 weeks of
taking the pills to no longer spread TB germs to other people. Patients need to
stay on the medicines to be cured even if they start to feel better.
A quarter of the global population is infected with
LTBI of which 10 percent will develop active TB.
TB can be diagnosed through skin tests, blood tests,
x-rays, and other tests.
The treatment regimens for LTBI are isoniazid for
6 to 9 months, INH and rifapentine (RPT) for 3
months, or rifampin for four months.
While all the regimens are effective,
it is best for the patient and the doctor to decide the right medicine.
Patients are more likely to complete shorter treatment regimens.
- Safety and Side Effects of Rifampin versus Isoniazid in Children - (https://www.nejm.org/doi/full/10.1056/NEJMoa1714284)
- Treatment Regimens for Latent TB Infection (LTBI) - (https://www.cdc.gov/tb/topic/treatment/ltbi.htm)