Effectiveness of 3 months of rifampicin and isoniazid chemoprophylaxis for the treatment of latent tuberculosis infection in children
Effectiveness of 3 months of rifampicin and isoniazid chemoprophylaxis for the treatment of latent tuberculosis infection in children
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DOI：
10.1136/adc.2010.182600
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发表时间：
2010-08-01
影响因子：
5.2
通讯作者：
Ormerod, L. P.
中科院分区：
文献类型：
--
作者：
Bright-Thomas, R.;Nandwani, S.;Ormerod, L. P.
背景/背景自1989年以来，当地一直使用利福平（R）和异烟肼（H）（3RH）治疗潜伏性结核感染（LTBI）3个月，LTBI定义为结核菌素皮肤试验不适当的阳性，无临床或X线证据。在英国，这种治疗方案在儿童中的疗效仅进行了间接研究。这些儿童与3RH治疗的长期结果，在这个高结核病（TB）发病率区的胸科诊所，进行了研究，以获得一个更直接的评估effictiveness.Methods所有的儿童与3RH治疗LTBI从1989年至2004年包容性匹配与当地的病人管理系统（PAS），GP登记和当地的结核病通知数据库。只有那些人仍然登记在当地的PAS，或当地GP登记，然后检查随后的TB notify.Results共确定了334例患者，其中252人留在当地，与82失去了后续行动; 252例中有3例（1.19%）发生临床肺结核，3113年（平均12.35年）观察结果为0.964/1000人年（95%CI0.199 ~ 2.816）。敏感性分析显示，“最佳情况”方案为0.727/1000人年（95% CI 0.15 - 2.12），如果10%失访者发生临床TB，则为2.66/1000人年（95%CI 1.33 ~ 4.77）。结论3RH治疗后平均随访12.35年，观察时间超过3100患者年，显示活动性结核病的发病率低于1/1000患者年。这表明3RH在英国用于治疗儿童LTBI时具有非常高的疗效，并且与预期的未治疗结核病率相比具有优势。
Background/setting Treatment for 3 months with rifampicin (R) and isoniazid (H) (3RH) for latent tuberculosis infection (LTBI), defined as an inappropriately positive tuberculin skin test with no clinical or x-ray evidence of disease, has been used locally since 1989. The efficacy of this regimen in children in the UK has only been studied indirectly. The long-term outcome of those children treated with 3RH, in the Chest Clinic of this high tuberculosis (TB) incidence district, has been studied to derive a more direct assessment of effectiveness.Methods All children treated with 3RH for LTBI from 1989 to 2004 inclusive were matched with the local patient administration system (PAS), GP registration and local TB notification databases. Only those persons still registered locally on PAS, or locally GP registered were then checked for subsequent TB notification.Results A total of 334 patients were identified, of whom 252 remained locally, with 82 lost to follow-up; 3 cases of clinical TB developed in the 252 (1.19%), with 3113 years observation (mean 12.35 years) giving 0.964/1000 person years (95% CI 0.199 to 2.816). Sensitivity analyses showed a 'best case' scenario of 0.727/1000 person years (95% CI 0.15 to 2.12), and if 10% of those lost to follow-up developed clinical TB of 2.66/1000 person years (95% CI 1.33 to 4.77).Conclusions Follow-up of those cases treated with 3RH, for a mean of 12.35 years, and over 3100 patient years observation, shows a rate of active TB of under 1/1000 patient years. This suggests that 3RH has very high efficacy when used to treat LTBI in children in the UK and compares favourably with the expected untreated TB rate.