Intermittent versus daily therapy for treating tuberculosis in children

Bose, Anuradha; Kalita, Soumik; Rose, Winsley; Tharyan, Prathap

doi:10.1002/14651858.cd007953.pub2

Cited by 15 publications

(17 citation statements)

References 64 publications

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“…A Cochrane review comparing intermittent with daily therapy in children with PTB found no detectable difference between twice-weekly and daily treatment in outcomes, but the data were insufficient to support or refute the use of intermittent treatment over daily treatment in children with tuberculosis. 41 No randomized controlled trials have studied intermittent therapy for extrapulmonary tuberculosis. For extrapulmonary tuberculosis including TBM, daily therapy is recommended in both the intensive and continuation phase.…”

Section: Practical Aspects Of Treatmentmentioning

confidence: 99%

Treatment of Central Nervous System Tuberculosis

Ahmed

2018

J Pediatr Infect Dis

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Central nervous system tuberculosis (CNS-TB) manifests as tuberculous meningitis, intracranial tuberculoma, or spinal tuberculous arachnoiditis. Children are disproportionately affected, with high rates of mortality and morbidity reported even in the era of treatment. Most guidelines for the treatment of drug-susceptible CNS-TB recommend 9 to 12 months of a standard regimen of isoniazid, rifampin, pyrazinamide, and ethambutol, with the adjunctive use of corticosteroids early in therapy. Recent trials have demonstrated improved outcomes with intensified regimens using nonstandard regimens or higher dosages of standard drugs. Accumulating evidence also supports shorter duration of treatment. Further investigation is warranted to identify the optimal regimen and duration of treatment for CNS-TB. Complications such as hydrocephalus may be managed medically or surgically. Although outcomes have improved with effective chemotherapy and immunomodulation of disease, prompt diagnosis and treatment in the early stages of disease remain paramount to improve prognosis.

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Section: Practical Aspects Of Treatmentmentioning

confidence: 99%

Treatment of Central Nervous System Tuberculosis

Ahmed

2018

J Pediatr Infect Dis

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“…Mere DOTS without specific efforts such as transport coupons or food rations does not increase compliance [9]. A publication by Bose et al in the Cochrane Database of Systematic Reviews compared the efﬁcacy and safety of intermittent, short-course anti-TB regimens (twice- or thrice-weekly) with daily short-course anti-TB regimens in treating childhood TB [10]. This review noted that parents of children should be educated regarding the need for adherence and treatment completion and appropriately compensated for trial-related expenses, to ensure continued participation.…”

Section: Introductionmentioning

confidence: 99%

Rapid assessment of facilitators and barriers related to the acceptance, challenges and community perception of daily regimen for treating tuberculosis in India

Negandhi

Tiwari

Sharma

et al. 2017

Global Health Action

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Introduction: The Revised National Tuberculosis Control Program (RNTCP) is the largest tuberculosis (TB) control program in the world based on Directly Observed Treatment Short-Course (DOTS) strategy. Globally, most countries have been using a daily regimen and in India a shift towards a daily regimen for TB treatment has already begun. The daily strategy is known to improve program coverage along with compliance. Such strategic shifts have both management and operational implications. We undertook a rapid assessment to understand the facilitators and barriers in adopting the daily regimen for TB treatment in three Indian states. Methods: In-depth interviews were planned across six districts of three purposively selected states of Maharashtra, Bihar and Sikkim, among health system personnel at various levels to identify their perspectives on adoption of a daily regimen for TB. These districts were sampled on the basis of TB notification rates. Thematic analysis of the qualitative data was undertaken. Results: 62 respondents were interviewed from these 6 districts. During the analysis, it was observed that an easily accessible, patient-centred and personalized outreach is an enabling factor for adherence to treatment. Lack of transportation facilities, out-of-pocket expenses and loss of wages for accessing DOTS at institutions are major identified barriers for treatment adherence at individual level. At program level, lack of trained service providers, poor administration of treatment protocols and inadequate supervision by health care providers and program managers are key factors that influence program outcomes. Conclusion: A major observation that emerged from the interviews is that the key to achieve a relapse-free cure is ensuring that a patient receives all doses of the prescribed treatment regimen. However, switching to a daily regimen makes adherence difficult and thus new strategies are needed for its implementation at patient and health provider levels. Most stakeholders appreciate the reasons for switching to a daily regimen. The stakeholders recognised the efforts of the Ministry of Health & Family Welfare (MoHFW) in spearheading the program. Strategies like the 99 DOTS call-centre approach may also further ensure treatment adherence.

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“…The recent Cochrane review comparing daily versus intermittent anti-tuberculosis therapy in children 1 reported that there is no obvious difference between the two treatment regimens. The authors also highlighted the poor quality of individual trials, leading to this result.…”

Section: Introductionmentioning

confidence: 99%

“…This review's conclusion is completely different from that published in a previous systematic review by another group 2 despite examination of the same trials and dataset. 3e6 The main reason for this difference has been explained in the Cochrane review 1 as an error in data extraction (and hence meta-analysis) by the authors of the previous systematic review. 2 In that respect, the Cochrane review 1 is a valuable addition to scientific literature and can be taken as the current best evidence on the subject.…”

Section: Introductionmentioning

confidence: 99%

Evidence in health-care practice! Missing the forest for the trees?

Mathew

2014

Clinical Epidemiology and Global Health

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A Cochrane review (published in 2014) reported that daily therapy is comparable to intermittent therapy in children with tuberculosis. This is contrary to another systematic review (published in 2010) that included the same trials and dataset, based on which the World Health Organization recommended daily treatment in preference to intermittent therapy. This commentary explores the practical challenges involved in using secondary research (from systematic reviews) to inform decisions by various stakeholders in healthcare. These include the technical and statistical jargon associated with systematic reviews, the distinction between reviews providing answers to clinical questions as opposed to decision questions, the place of 'tertiary research' to facilitate evidence-informed healthcare, and the hierarchy within systematic reviews. A potential solution to overcome these challenges and enable stakeholders to use evidence to inform decisions, is to empower them with knowledge and skills to interpret such research, in parallel with its production and dissemination.

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Intermittent versus daily therapy for treating tuberculosis in children

Abstract: Intermittent versus daily therapy for treating tuberculosis in children.

Cited by 15 publications

References 64 publications

Treatment of Central Nervous System Tuberculosis

Treatment of Central Nervous System Tuberculosis

Rapid assessment of facilitators and barriers related to the acceptance, challenges and community perception of daily regimen for treating tuberculosis in India

Evidence in health-care practice! Missing the forest for the trees?

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