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Published ahead of print on November 21, 2002, doi:10.1164/rccm.200209-998OC

Am. J. Respir. Crit. Care Med., Volume 167, Number 6, March 2003, 824-827

A more recent version of this article appeared on March 15, 2003
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Submitted on September 6, 2002
Accepted on November 20, 2002

Safety of 2 months of rifampin and pyrazinamide for treatment of latent tuberculosis

Jason E Stout1*, John J Engemann1, Allen C Cheng1, Ellen R Fortenberry2, and Carol D Hamilton1

1 Division of Infectious Diseases, Duke University Medical Center, Durham, NC, USA, 2 Communicable Diseases, Wake County Human Services, Raleigh, NC, USA

* To whom correspondence should be addressed. E-mail: stout002{at}mc.duke.edu.

Two months of rifampin (RIF) and pyrazinamide (PZA) is an alternative regimen for treatment of latent tuberculosis infection (LTBI), but some patients have died of hepatitis associated with this therapy. 114 patients received RIF/PZA for LTBI in Wake County, North Carolina between December 1999 and May 2002. 60.5% of these patients were homeless and at least 17% drank alcohol to excess. 77 (67.5%) patients completed a full two-month course. Nine patients had a history of viral hepatitis or chronic liver disease. 4/114 (3.5%, 95% confidence interval (95% CI) 1.0-8.7 %) patients developed hepatitis on RIF/PZA, and another 2 had symptoms consistent with hepatitis, but did not report for lab testing (total confirmed plus suspected hepatitis rate 5.3%, 95% CI 2.0-11.1%). No patient who developed hepatitis on RIF/PZA had a history of viral hepatitis or liver disease, and none had been previously treated with isoniazid. No patients died or were hospitalized due to drug side effects. RIF/PZA was associated with a significantly higher rate of hepatitis than previously described with INH therapy for LTBI, but resulted in a high completion rate. The RIF/PZA regimen for LTBI may be useful for high-risk, traditionally nonadherent patient groups, but careful monitoring for toxicity is required.
Key words: tuberculosis, hepatitis, side effects




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