Management of Latent Tuberculosis Infection in Child Contacts of Multidrug-Resistant Tuberculosis

Abstract

After exposure to a teacher with multidrug-resistant pulmonary tuberculosis, 31 children developed latent infection. Twenty-six were treated with levofloxacin and pyrazinamide. Twelve required a change in therapy secondary to adverse effects. The most common adverse effects included abdominal pain, arthralgias/myalgias and elevated transaminases. All children reported at least 1 adverse effect. Fifteen children completed treatment. All adverse effects were transient.

Preventing the spread of multidrug-resistant tuberculosis and protecting contacts of infectious cases

“…Pyrazinamide is excluded, given the substantial toxicity and high rates of discontinuation reported in observational studies where the drug was used [58][59][60]. For contacts of MDR-TB plus fluoroquinolone resistance cases with low-level isoniazid resistance, some authors suggest the use of high-dose isoniazid [61], however there is no evidence to support this approach.…”

Systematic Review, Meta-analysis, and Cost-effectiveness of Treatment of Latent Tuberculosis to Reduce Progression to Multidrug-Resistant Tuberculosis

“…After combining data from the comparison studies of Adler-Shohet et al [22], Bamrah et al [19], Denholm et al [20], Schaaf et al [21], and Williams et al [23], we found a statistically significant reduction in TB incidence among treated vs untreated persons (Figure 2). The reduction in MDR TB incidence was found using several methods (a 91%–92% risk reduction controlling for person-time using Poisson regression alone or controlling for zero inflation and random effects) to analyze count data with multiple zero outcomes.…”

“…Of the 6 comparison studies, all but Bamrah et al [19] (Micronesia) and Schaaf et al [21] (South Africa) were conducted in countries having low TB incidence: Adler-Shohet et al [22] (United States), Attamna et al [7] (Israel), Denholm et al [20] (Australia), and Williams et al [23] (United Kingdom). Among the studies in low-incidence settings, only Denholm et al reported any TB cases (2/49 [4%] study subjects) after 2–6 years following treated and untreated persons.…”

“…Adler-Shohet et al [22] observed 31 children with MDR-LTBI prospectively for 2 years in California. Twenty-six were treated with LEV and pyrazinamide (PZA) for 9 months, and 57% (15/26) completed treatment.…”

Moxifloxacin Prophylaxis against MDR TB, New York, New York, USA

“…Studies demonstrate serious adverse effects associated with the use of pyrazinamide in combination with either ethambutol ( 10 ) or a fluoroquinolone, including ofloxacin ( 11 , 12 ) and levofloxacin ( 13 , 14 ). However, a recent study of contacts treated with moxifloxacin- or levofloxacin-based prophylaxis found no serious adverse events and fewer cases of disease among those treated than those untreated ( 15 ).…”