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Latent tuberculosis infection in children: a call for revised treatment guidelines Finnell SM; Christenson JC; Downs SMPediatrics 2009[Mar]; 123 (3): 816-22BACKGROUND: Guidelines for latent tuberculosis infection do not consider drug-resistance patterns when recommending treatment for immigrant children. OBJECTIVES: The purpose of this research was to decide at what rate of isoniazid resistance a different regimen other than isoniazid for 9 months should be considered. METHODS: We constructed a decision tree by using published data. We studied 3 regimens considered to be effective for susceptible organisms: (1) isoniazid for 9 months, (2) rifampin for 6 months, and (3) isoniazid for 9 months plus rifampin for 6 months. In addition, we evaluated a regimen of isoniazid and rifampin for 3 months. Our base case was a 2-year-old child from Russia with a tuberculin skin test reaction of 12 mm. We assumed a societal perspective and expressed results as cost and cost per case of tuberculosis prevented. We conducted sensitivity analyses to test the stability of our model. RESULTS: In our baseline analysis, rifampin was the least costly treatment regimen for any child arriving from an area with an isoniazid-resistance rate of >/=11%. Treatment with isoniazid plus rifampin was the most effective but would cost more than $1 million per reactivation case prevented. Isoniazid would become the least costly regimen if any of the following thresholds were met: rifampin resistance given isoniazid resistance of more than 82%; rifampin resistance given no isoniazid resistance of >9%; cost of rifampin more than $47/month; effectiveness of rifampin lower than 63%; effectiveness of isoniazid higher than 74%; and cost of pulmonary tuberculosis less than $7661. Isoniazid and rifampin for 3 months was the least costly for all cases from areas with isoniazid resistance of <80% as long as the regimen's effectiveness was >50% for susceptible bacteria. However, this assumption remains to be proven. CONCLUSION: Because of the high prevalence of isoniazid resistance, rifampin should be considered for children with latent tuberculosis infection originating from countries with >11% isoniazid resistance.|*Emigrants and Immigrants[MESH]|*Practice Guidelines as Topic[MESH]|*Tuberculin Test[MESH]|Adoption[MESH]|Antitubercular Agents/economics/*therapeutic use[MESH]|Child, Preschool[MESH]|Cost-Benefit Analysis/statistics & numerical data[MESH]|Decision Trees[MESH]|Drug Administration Schedule[MESH]|Drug Costs/statistics & numerical data[MESH]|Drug Therapy, Combination[MESH]|Health Care Costs/statistics & numerical data[MESH]|Humans[MESH]|Indiana[MESH]|Isoniazid/economics/*therapeutic use[MESH]|Microbial Sensitivity Tests[MESH]|Rifampin/economics/therapeutic use[MESH]|Russia/ethnology[MESH]|Secondary Prevention[MESH]|Tuberculosis, Multidrug-Resistant/*drug therapy/economics[MESH] |
