Intermittent or daily short course chemotherapy for tuberculosis in children: Meta-analysis of randomized controlled trials
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To compare the effectiveness of intermittent with daily chemotherapy (both containing rifampicin) in childhood tuberculosis (age ≤16yrs) in achieving cure/significant improvement.
Systematic Review and Meta-analysis.
MEDLINE and the Cochrane Library were searched for randomized trials of antitubercular regimens containing rifampicin, in children 16 yrs or less with tuberculosis. Two reviewers independently assessed trial eligibility and quality. Data from full articles of selected studies were independently extracted by two authors and analyzed. The odds ratio was obtained for the pooled data in two groups (intermittent and daily therapy).
Cure/significant improvement, relapse rate and adverse events.
Four randomized controlled trials comparing twice weekly and daily therapy including 466 children pulmonary 439; extrapulmonary 27) met the inclusion criteria. Baseline data were comparable. On quality assessment, 3 studies scored 2 and one study scored 3 out of 5 points. Per protocol analysis showed that children receiving intermittent regimen were less likely to be cured than those receiving daily therapy (OR 0.27; 95% CI: 0.14, 0.51). The results of intention to treat analysis suggest similar trend towards lower cure rates with twice weekly regimen (OR 0.66; 95% CI: 0.23–1.84).
Twice weekly intermittent short course therapy is less likely to cure tuberculosis in children as compared to daily therapy. There is a need for better quality randomized controlled trials for assessing efficacy of alternate schedule for intermittent therapy for childhood tuberculosis.
- Cohn, D.L., Catlin, B.J., Peterson, K.L., Judson, F.N., Sbarbaro, J.A. (1990) A 62-dose, 6-month therapy for pulmonary and extrapulmonary tuberculosis. A twice-weekly, directly observed and cost-effective regimen. Ann Intern Med 112: pp. 407-415
- Caminero, J.A., Pavón, J.M., Rodríguez de Castro, F., Díaz, F., Julià, G., Caylá, J.A. (1996) Evaluation of a directly observed six month fully intermittent treatment regimens for tuberculosis in patients suspected of poor compliance. Thorax 51: pp. 1130-1133 CrossRef
- Balasubramanian, R. (1991) Fully intermittent six month regimens for pulmonary tuberculosis in south India. Indian J Tuberc 38: pp. 51
- Bechan, S., Connolly, C., Short, G.M., Standing, E., Wilkinson, D. (1997) Directly observed therapy for tuberculosis given twice weekly in the workplace in urban South Africa. Trans Royal Soc Trop Med Hyg 91: pp. 704-707 CrossRef
- CDC core curriculum: treatment of TB Disease. http://www.umdnj.edu/~ntbcweb/coretrea.htm. Accessed on 12 December, 2007.
- Abernathy, R.S., Dutt, A.K., Stead, W.W., Moers, D.J. (1983) Short-course chemotherapy for tuberculosis in children. Pediatrics 72: pp. 801-806
- Iseman, M.D., Cohn, D.L., Sbarbaro, J.A. (1993) Directly observed treatment of tuberculosis — we can’t afford not to try it. N Engl J Med 328: pp. 576-578 CrossRef
- Dickersin, K., Scherer, R., Lefebvre, C. (1994) Systematic reviews: Identifying relevant studies for systematic reviews. BMJ 309: pp. 1286-1291
- Jadad, A.R., Moore, R.A., Carroll, D., Jenkinson, C., Reynolds, D.J., Gavaghan, D.J. (1996) Assessing the quality of reports of Randomized clinical trials: is blinding necessary?. Controlled Clin Trials 17: pp. 1-12 CrossRef
- Review Manager (RevMan). Version 4.2 for Windows. The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen
- Dingley, H.B. (1982) Short-term chemotherapy in tuberculosis in children. Indian J Tuberc 29: pp. 48-54
- Jawahar, M.S., Rajaram, K., Sivasubramanian, S., Paramasivan, C.N., Chandrasekar, K., Kamaludeen, M.N. (2005) Treatment of lymph node tuberculosis—a randomized clinical trial of two 6-month regimens. Trop Med Int Health 10: pp. 1090-1098 CrossRef
- Rajeswari, R., Sivasubramanian, S., Balambal, R., Parthasarathy, R., Ranjani, R., Santha, T. (1995) A controlled clinical trial of short-course chemotherapy for tuberculoma of the brain. Tuber Lung Dis 76: pp. 311-317 CrossRef
- Balasubramanian, R., Nagarajan, M., Balambal, R., Tripathy, S.P., Sundararaman, R., Venkatesan, P. (1997) Randomised controlled clinical trial of short course chemotherapy in abdominal tuberculosis: a five-year report. Int J Tuberc Lung Dis 1: pp. 44-51
- Anonymous. Controlled clinical trial of oral short-course regimens in the treatment of sputum-positive pulmonary tuberculosis. Tuberculosis Research Centre. Int J Tuberc Lung Dis 1997;1:509–517.
- Swaminathan, S., Raghavan, A., Duraipandian, M., Kripasankar, A.S., Ramachandran, P. (2005) Short course chemotherapy for pediatric respiratory tuberculosis: 5-year report. Int J Tuberc Lung Dis 9: pp. 693-696
- Ramachandran, P., Kripasankar, A.S., Duraipandian, M. (1998) Short Course Chemotherapy for pulmonary tuberculosis in children. Indian J Tuberc 45: pp. 83-87
- Kansoy, S., Kurtap, N., Akpit, S., Aksoylar, S., Yaprak, I., Çaðlayan, S. (1996) Superiority of intermittent-short course chemotherapy in childhood pulmonary tuberculosis. Turkish J Med Sci 26: pp. 41-43
- Kumar, L., Dhand, R., Singhi, P.D., Rao, K.L., Katariya, S. (1990) A randomised trial of fully intermittent and daily followed by intermittent short-course chemotherapy for childhood tuberculosis. Pediatr Infect Dis J 9: pp. 802-806 CrossRef
- Water Naude, J.M., Donald, P.R., Hussey, G.D., Kibel, M.A., Louw, A., Perkins, D.R. (2000) Twiceweekly vs daily chemotherapy for childhood TB. Pediatr Infect Dis J 19: pp. 405-410 CrossRef
- Provisional guidelines for the diagnosis and classification of the EPI target diseases for primary health care, surveillance and special studies. EPI/GEN/83/4. WHO, Geneva
- Mwandumba, H.C., Squire, S.B. (2001) Fully intermittent dosing with drugs for treating tuberculosis in adults. Cochrane Database Syst Rev 4: pp. CD000970
- Cox, H.S., Morrow, M., Deutschmann, P.W. (2008) Long term efficacy of DOTS regimens for tuberculosis: systematic review. BMJ 336: pp. 484-487 CrossRef
- Walley, J.D., Khan, M.A., Newell, J.N., Khan, M.H. (2001) Effectiveness of the direct observation component of DOTS for tuberculosis: a randomized controlled trial in Pakistan. Lancet 357: pp. 664-669 CrossRef
- Snider, D.E., Graczyk, J., Bek, E., Rogowski, J. (1984) Supervised six-months treatment of newly diagnosed pulmonary tuberculosis using isoniazid, rifampin, and pyrazinamide with and without streptomycin. Am Rev Respir Dis 130: pp. 1091-1094
- Intermittent or daily short course chemotherapy for tuberculosis in children: Meta-analysis of randomized controlled trials
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