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Published ahead of print on May 13, 2003, doi:10.1164/rccm.200303-390OC

Am. J. Respir. Crit. Care Med., Volume 168, Number 4, August 2003, 443-447

A more recent version of this article appeared on August 15, 2003
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Submitted on March 19, 2003
Accepted on May 8, 2003

Use of Isoniazid for Latent Tuberculosis Infection in a Public Health Clinic

Philip A LoBue1* and Kathleen S Moser2

1 Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, GA, USA; Tuberculosis Control Program, County of San Diego Health and Human Services Agency, San Diego, CA, USA; Division of Pulmonary and Critical Care Medicine, University of California - San Diego School of Medicine, San Diego, CA, USA, 2 Tuberculosis Control Program, County of San Diego Health and Human Services Agency, San Diego, CA, USA

* To whom correspondence should be addressed. E-mail: philip.lobue{at}sdcounty.ca.gov.

Isoniazid is an efficacious treatment for latent tuberculosis. Concerns remain, however, regarding hepatotoxicity associated with this medication. In addition, adherence may be suboptimal because at least six months of treatment is required. We extracted information from our latent tuberculosis treatment database to determine adverse effects and treatment completion rates associated with the use of isoniazid at a county tuberculosis clinic. Outcomes were available for 3788 patients started on isoniazid between 1999 and 2002. Six hundred and seventy-two patients (18%) experienced one or more adverse effects, including ten (0.3%) determined to have isoniazid-associated liver injury. No hospitalizations or deaths occurred in patients experiencing an adverse effect. A higher incidence of adverse effects was associated with increasing age. Sixty-four percent of patients completed at least six months of isoniazid. Higher completion rates were associated with younger age, Hispanic ethnicity and non-US country of birth. Lower completion rates were associated with homelessness, excess alcohol use and having experienced an adverse effect. In summary, we conclude that in our clinic population isoniazid is a safe therapy for latent tuberculosis, but its effectiveness is limited by modest completion rates.
Key words: isoniazid,latent tuberculosis,hepatotoxicity,adherence,adverse effects




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