Twice-weekly therapy for children with tuberculosis infection or exposure

SETTING: Children's tuberculosis clinic, Houston, TX, United States. OBJECTIVE: To determine the safety, adherence and efficacy of intermittent directly observed preventive therapy (DOPT). DESIGN: Retrospective cohort of children receiving intermittent DOPT for exposure to tuberculosis (TB) or latent TB infection (LTBI) seen from 1989 to 2011 at one clinic. RESULTS: A total of 1383 children were treated for either TB exposure for 2-3 months (n = 935, 68%) or LTBI for 9 months (n = 448, 32%) with isoniazid 20-30 mg/kg/dose or rifampin 10-15 mg/kg/dose biweekly. All children with exposure and 411 (92%) with LTBI were identified via contact investigations. Twelve (1.3%) children with exposure experienced adverse effects (5 abdominal pain, 4 vomiting, 3 rash); 8 had transaminases evaluated and only 1 had elevated levels. Thirty (6.7%) children with LTBI experienced adverse effects (16 abdominal pain, 6 rash, 3 vomiting, 3 headache and 2 abdominal pain/vomiting); 19 had transaminases obtained and 2 had elevated transaminases. All transaminases normalized after the discontinuation of medication. Over 99% of exposed and 95.8% of infected children completed treatment. One child, who had sickle cell anemia, was treated for LTBI and later developed TB disease. When compared to rates of disease progression by age, the efficacy of intermittent DOPT was 98%. CONCLUSION: Intermittent DOPT in childhood TB is safe, effective and offers high adherence rates.