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

Am J Respir Crit Care Med. 2003 Mar 15;167(6):824-7. doi: 10.1164/rccm.200209-998OC. Epub 2002 Nov 21.

Abstract

An alternative regimen for the treatment of latent tuberculosis infection is 2 months of rifampin and pyrazinamide, but some patients have died of hepatitis associated with this therapy. One hundred fourteen patients received rifampin/pyrazinamide 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. Seventy-seven patients (67.5%) completed a full 2-month course. Nine patients had a history of viral hepatitis or chronic liver disease. Four of 114 (3.5%; 95% confidence interval, 1.0-8.7%) patients developed hepatitis on therapy, and another two had symptoms consistent with hepatitis but did not report for laboratory testing (total confirmed plus suspected hepatitis rate 5.3%; 95% confidence interval, 2.0-11.1%). No patient who developed hepatitis 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. Rifampin/pyrazinamide was associated with a significantly higher rate of hepatitis than previously described with isoniazid therapy for latent tuberculosis but resulted in a high completion rate. The rifampin/pyrazinamide regimen for latent tuberculosis infection may be useful for high-risk, traditionally nonadherent patient groups, but careful monitoring for toxicity is required.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Alcoholism / complications
  • Antibiotics, Antitubercular / adverse effects*
  • Antitubercular Agents / adverse effects*
  • Chemical and Drug Induced Liver Injury / diagnosis
  • Chemical and Drug Induced Liver Injury / etiology
  • Child
  • Child, Preschool
  • Cohort Studies
  • Comorbidity
  • Drug Administration Schedule
  • Drug Monitoring
  • Drug Therapy, Combination
  • Female
  • Hepatitis B / complications
  • Hepatitis C / complications
  • Homeless Persons
  • Humans
  • Infant
  • Liver Diseases / complications
  • Male
  • Middle Aged
  • North Carolina
  • Pyrazinamide / adverse effects*
  • Rifampin / adverse effects*
  • Safety*
  • Treatment Outcome
  • Tuberculosis / drug therapy*
  • Tuberculosis / etiology

Substances

  • Antibiotics, Antitubercular
  • Antitubercular Agents
  • Pyrazinamide
  • Rifampin