PMID- 28329197
OWN - NLM
STAT- MEDLINE
DCOM- 20180222
LR  - 20220409
IS  - 1537-6591 (Electronic)
IS  - 1058-4838 (Print)
IS  - 1058-4838 (Linking)
VI  - 64
IP  - 12
DP  - 2017 Jun 15
TI  - Systematic Review, Meta-analysis, and Cost-effectiveness of Treatment of Latent 
      Tuberculosis to Reduce Progression to Multidrug-Resistant Tuberculosis.
PG  - 1670-1677
LID - 10.1093/cid/cix208 [doi]
AB  - BACKGROUND. Evidence-based recommendations for treating persons having presumed 
      latent tuberculosis (LTBI) after contact to infectious multidrug-resistant (MDR) 
      tuberculosis (TB) are lacking because published data consist of small 
      observational studies. Tuberculosis incidence in persons treated for latent MDR 
      -TB infection is unknown. METHODS. We conducted a systematic review of studies 
      published 1 January 1994-31 December 2014 to analyze TB incidence, treatment 
      completion and discontinuation, and cost-effectiveness. We considered contacts 
      with LTBI effectively treated if they were on >/=1 medication to which their MDR-TB 
      strain was likely susceptible. We selected studies that compared treatment vs 
      nontreatment outcomes and performed a meta-analysis to estimate the relative risk 
      of TB incidence and its 95% confidence interval. RESULTS. We abstracted data from 
      21 articles that met inclusion criteria. Six articles presented outcomes for 
      contacts who were treated compared with those not treated for MDR-LTBI; 10 
      presented outcomes only for treated contacts, and 5 presented outcomes only for 
      untreated contacts. The estimated MDR-TB incidence reduction was 90% (9%-99%) 
      using data from 5 comparison studies. We also found high treatment 
      discontinuation rates due to adverse effects in persons taking 
      pyrazinamide-containing regimens. Cost-effectiveness was greatest using a 
      fluoroquinolone/ethambutol combination regimen. CONCLUSIONS. Few studies met 
      inclusion criteria, therefore results should be cautiously interpreted. We found 
      a reduced risk of TB incidence with treatment for MDR-LTBI, suggesting 
      effectiveness in prevention of progression to MDR-TB, and confirmed 
      cost-effectiveness. However, we found that pyrazinamide-containing MDR-LTBI 
      regimens often resulted in treatment discontinuation due to adverse effects.
CI  - Published by Oxford University Press for the Infectious Diseases Society of 
      America 2017. This work is written by (a) US Government employee(s) and is in the 
      public domain in the US.
FAU - Marks, Suzanne M
AU  - Marks SM
AD  - Division of Tuberculosis Elimination, Centers for Disease Control and 
      Prevention,Atlanta, Georgia.
FAU - Mase, Sundari R
AU  - Mase SR
AD  - Division of Tuberculosis Elimination, Centers for Disease Control and 
      Prevention,Atlanta, Georgia.
FAU - Morris, Sapna Bamrah
AU  - Morris SB
AD  - Division of Tuberculosis Elimination, Centers for Disease Control and 
      Prevention,Atlanta, Georgia.
LA  - eng
GR  - CC999999/Intramural CDC HHS/United States
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
PL  - United States
TA  - Clin Infect Dis
JT  - Clinical infectious diseases : an official publication of the Infectious Diseases 
      Society of America
JID - 9203213
RN  - 0 (Antitubercular Agents)
RN  - 0 (Fluoroquinolones)
RN  - 2KNI5N06TI (Pyrazinamide)
RN  - 8G167061QZ (Ethambutol)
SB  - IM
EIN - Clin Infect Dis. 2017 Oct 15;65(8):1433-1434. PMID: 29017257
MH  - Antitubercular Agents/administration & dosage/economics/*therapeutic use
MH  - Cost-Benefit Analysis
MH  - Disease Progression
MH  - Drug Resistance, Multiple, Bacterial/*drug effects
MH  - Ethambutol/economics/therapeutic use
MH  - Fluoroquinolones/economics/therapeutic use
MH  - Humans
MH  - Latent Tuberculosis/*drug therapy/economics
MH  - Pyrazinamide/economics/therapeutic use
MH  - Treatment Outcome
MH  - Tuberculosis, Multidrug-Resistant/*drug therapy/economics
PMC - PMC5543758
MID - NIHMS879075
OTO - NOTNLM
OT  - contacts
OT  - cost.
OT  - multidrug-resistant
OT  - treatment
OT  - tuberculosis
COIS- Potential conflicts of interest. All authors: No potential conflicts. All authors 
      have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. 
      Conflicts that the editors consider relevant to the content of the manuscript 
      have been disclosed.
EDAT- 2017/03/23 06:00
MHDA- 2018/02/23 06:00
PMCR- 2017/12/15
CRDT- 2017/03/23 06:00
PHST- 2016/10/28 00:00 [received]
PHST- 2017/03/06 00:00 [accepted]
PHST- 2017/03/23 06:00 [pubmed]
PHST- 2018/02/23 06:00 [medline]
PHST- 2017/03/23 06:00 [entrez]
PHST- 2017/12/15 00:00 [pmc-release]
AID - 3069791 [pii]
AID - 10.1093/cid/cix208 [doi]
PST - ppublish
SO  - Clin Infect Dis. 2017 Jun 15;64(12):1670-1677. doi: 10.1093/cid/cix208.