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Tuberculosis in Childhood and Pregnancy
Published in Lloyd N. Friedman, Martin Dedicoat, Peter D. O. Davies, Clinical Tuberculosis, 2020
Lindsay H. Cameron, Jeffrey R. Starke
The rates of adverse reactions to antituberculosis medications are low enough in children and adolescents that routine baseline and monitoring of hepatic function tests is not necessary. If there is a previous history of hepatitis, obesity (fatty liver) or other chronic illness, it is advisable to obtain a baseline hepatic function panel. If the patient or family reports any symptoms that could be adverse reactions to antituberculosis medications, the child should have a complete physical examination and a hepatic function panel (including bilirubin level determination). Serum liver enzyme elevations of 2 times normal are fairly common and do not necessitate discontinuation of medications if all other findings are normal. Pyrazinamide may cause mild arthralgia or arthritis that is usually transient. Rash and severe pruritus are less common in children. Children receiving ethionamide should have baseline thyroid function testing and monitoring every 6 months to evaluate for hypothyroidism. Rifapentine can cause muscle aches that are generally self-limited and require no intervention. Adverse reactions with fluoroquinolones are uncommon.
Rifapentine
Published in M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson, Kucers’ The Use of Antibiotics, 2017
Studies assessing the use of rifapentine in the treatment of TB are summarized in Table 129.1. In a study conducted in Hong Kong in patients with pulmonary tuberculosis, isoniazid (15 mg/kg) and rifapentine (600 mg) given once weekly in the continuation phase was compared with three-times-weekly isoniazid and rifampicin after a standard 2-month four-drug intensive phase that included streptomycin. After 5 years of follow-up, relapse rates were 10.8% in the rifapentine group and 4.2% in the rifampicin comparator arm. This study used rifapentine of Chinese manufacture, the bioavailabilty of which was lower than anticipated, necessitating an increased dose of 750 mg during the latter part of the trial (Mitchison, 1998; Tam et al., 2002). By multivariate analysis, older age, male sex, and extensive disease on chest radiography were risk factors for relapse.
Human Immunodeficiency Virus and Tuberculosis Co-Infection
Published in Peter D O Davies, Stephen B Gordon, Geraint Davies, Clinical Tuberculosis, 2014
Intermittent regimens with standard TB medications given twice or three times per week are sometimes considered for the treatment of TB in HIV-uninfected patients; however, several studies have shown that these regimens in HIV-infected patients – particularly during the intensive phase – are associated with treatment failure, relapse and acquired drug resistance [120–122]. Twice-weekly regimens are also associated with a poorer outcome during the continuation phase of treatment [123]. Based on this evidence, HIV-infected patients should almost always receive daily treatment during the intensive phase (five or seven doses per week) and daily or three times weekly treatment during the continuation phase. Rifapentine, a long-acting rifamycin, given weekly or twice-weekly in non-cavitatory drug-sensitive TB in HIV negative subjects, is not recommended for the treatment of HIV-associated TB.
Chapter 9: Pediatric tuberculosis
Published in Canadian Journal of Respiratory, Critical Care, and Sleep Medicine, 2022
Rachel Dwilow, Charles Hui, Fatima Kakkar, Ian Kitai
RecommendationsWe strongly recommend that, in children ≥2 years old, TB infection be treated with either 12 weeks of once-weekly isoniazid and rifapentine (3HP, where available) or 4 months of daily rifampin (good evidence).We strongly recommend that, in children <2 years old, 9 months of daily isoniazid be an acceptable alternative given its historical use (good evidence).We conditionally recommend that, in children <2 years old, 4 months of daily rifampin (4R) be prescribed for TB preventive therapy (poor evidence).
Treatment for latent tuberculosis infection in low- and middle-income countries: progress and challenges with implementation and scale-up
Published in Expert Review of Respiratory Medicine, 2020
Anthony D. Harries, Ajay M. V. Kumar, Srinath Satyanarayana, Kudakwashe C. Takarinda, Collins Timire, Riitta A. Dlodlo
Rifapentine (RPT, a long-acting rifamycin) has been extensively studied in the last few years as a useful TB prevention drug. A systematic review in 2018 assessed the effects of 3 months, weekly rifapentine plus isoniazid (3HP), given as a total of 12 doses, compared with daily 6- or 9-months IPT in adult PLHIV and HIV-uninfected adults, adolescents and children [80]. Efficacy was similar to IPT in all the groups, the risk of hepatotoxicity was less in adults with and without HIV and there were higher completion rates of therapy. In the United States, self-administered therapy with monthly monitoring with or without weekly text messaging was found to be non-inferior to direct observation [81], but more work is needed in this area as there are indications that 3HP is more cost-effective when given by direct observation [82]. A course of 3HP is currently much more expensive than a course of IPT (in the USA, between USD$300-500 compared with <USD$10) [83]. However, cost-effectiveness studies do suggest that 3HP could be a suitable alternative to IPT if the cost can be reduced to USD$20 per course and high treatment completion >85% can be achieved [84].
Current research toward optimizing dosing of first-line antituberculosis treatment
Published in Expert Review of Anti-infective Therapy, 2019
Helen McIlleron, Maxwell T Chirehwa
Crushing of tablets before administration is common in young children as suitable formulations are frequently not available for those unable to swallow whole tablets. Adults on regimens involving the ingestion of multiple drugs may also prefer take their tablets crushed [106]. Crushing of tablets before mixing with water may reduce bioavailability as was demonstrated for rifapentine [118]. While formal studies of medicine administration practices in the home are scant, crushed tablets are frequently mixed together in water or another vehicle before swallowing. Drugs may then interact with other drugs or substances in the mixture, for example: some fluoroquinolones are chelated by divalent cations such as Fe++ and Ca++ [119,120]; certain sugars interact with the absorption of isoniazid [121]; and, as discussed above, terizidone may interfere with the absorption of isoniazid.