Tuberculosis Preventive Therapy for Individuals Exposed to Drug-resistant Tuberculosis: Feasibility and Safety of a Community-based Delivery of Fluoroquinolone-containing Preventive Regimen.

Abstract

BACKGROUND:

Observational studies have demonstrated the effectiveness of a fluoroquinolone-based regimen to treat individuals presumed to be infected with drug-resistant tuberculosis (DR-TB). We sought to assess the feasibility of this approach in an urban setting in South Asia.

METHODS:

From February 2016 until March 2017, all household contacts of DR-TB patients enrolled at the Indus Hospital were screened for TB symptoms at home. Children aged 0-17 years, symptomatic adults, and those with an immunocompromising condition (human immunodeficiency virus, diabetes, or malnutrition) were evaluated for TB disease. Contacts diagnosed with TB disease were started on treatment. Contacts without TB disease aged <5 years, contacts aged between 5 and 17 years with either a positive tuberculin skin test or an immunocompromising condition, or contacts aged ≥18 years with an immunocompromising condition were offered 6 months of treatment with a fluoroquinolone.

RESULTS:

One hundred households with 800 contacts were enrolled: 353 (44.1%) individuals aged ≤17 years with a median age of 19 years (interquartile range, 10-32); 423 (52.9%) were males. In total, 737 (92.1%) individuals were screened, of which 8 were already on treatment for TB (1.1%); another 3 (0.4%) contacts were diagnosed with TB disease and started on treatment. Of 215 eligible for infection treatment, 172 (80.0%) contacts initiated and 121 (70.3%) completed treatment. No TB disease or significant adverse events were observed during 12 months of follow-up.

CONCLUSIONS:

Fluoroquinolone-based treatment for contacts with presumed DR-TB infection is feasible and well tolerated in a high TB burden setting.

• Authors: Amyn A Malik, Junaid Fuad, Sara Siddiqui, Farhana Amanullah, Maria Jaswal, Zainab Barry, Farhat Jabeen, Razia Fatima, Courtney M Yuen, Naseem Salahuddin, Aamir J Khan, Salmaan Keshavjee, Mercedes C Becerra, Hamidah Hussain
• Journal: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America (Clin Infect Dis) Vol. 70 Issue 9 Pg. 1958-1965 (04 15 2020) ISSN: 1537-6591 [Electronic] United States
• PMID: 31190072 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: [email protected].

Chemical References

• Fluoroquinolones

Topics

• Adolescent
• Adult
• Asia
• Child
• Child, Preschool
• Contact Tracing
• Feasibility Studies
• Fluoroquinolones (therapeutic use)
• Humans
• Male
• Tuberculosis, Multidrug-Resistant (drug therapy, epidemiology, prevention & control)