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Treatment Completion and Costs of a Randomized Trial of Rifampin for 4 Months versus Isoniazid for 9 Months

Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, and Division of Clinical Epidemiology, Royal Victoria Hospital, McGill University, Montreal, Quebec, Canada

Correspondence and requests for reprints should be addressed to Dick Menzies, M.D., M.Sc., Montreal Chest Institute, 3650 St-Urbain, Room K1.24, Montreal, PQ, H2X 2P4 Canada. E-mail: dick.menzies{at}mcgill.ca

There is little published information regarding treatment completion, safety, and efficacy of rifampin administered daily for 4 months—a recommended alternative to 9 months of isoniazid for therapy of latent tuberculosis infection. In an open-label randomized trial at a university-affiliated respiratory hospital, consenting patients whose treating physician had recommended therapy for latent tuberculosis infection were randomized to daily self-administered rifampin for 4 months or daily self-administered isoniazid for 9 months. Of 58 patients randomized to rifampin, 53 (91%) took 80% of doses, and 50 (86%) took more than 90% of doses within 20 weeks compared with 44 (76%) and 36 (62%) who took 80 and 90%, respectively, of doses of isoniazid within 43 weeks (relative risks: 80% of doses, 1.2 [95% confidence interval: 1.02, 1.4]; 90% of doses, 1.4 [1.1, 1.7]). Adverse events resulted in permanent discontinuation of therapy for two (3%) patients taking rifampin, and for eight (14%) patients taking isoniazid. Three patients developed drug-induced hepatitis—all were taking isoniazid. Total costs of therapy were significantly higher for isoniazid. In conclusion, completion of therapy was significantly better with 4 months of rifampin and major side effects were somewhat lower. Further studies are needed to assess the safety and efficacy of the 4-month rifampin regimen.

Key Words: latent tuberculosis infection • treatment of latent tuberculosis infection • tuberculosis prevention

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