FIGURE
FIGURE
Drug Therapy to Prevent Tuberculosis Update: Adverse event data and revised American Thoracic Society/CDC recommendations against the use of rifampin and pyrazinamide for treatment of latent tuberculosis infection-United States, 2003. MMWR 2003, 52(31):735-739.
To quantify the risk of liver disease in patients who received rifampin and pyrazinamide (RZ) therapy to treat latent tuberculosis infection (LTBI), the Centers for Disease Control (CDC) collected data from additional patients. From October 2000 through June 2003, 48 patients had confirmed cases of severe liver injury and 11 of these (23%) died. In the group of 7,737 patients who started RZ for treatment of LTBI, the rate of hospitalization and death for severe liver injury was 3 per 1,000 treatment initiations (daily dosing) and 0.9 per 1,000 treatment initiations (twice-weekly doses).
In comparison, isoniazid therapy for LTBI has a median risk of hospitalization of 0.15 per 1,000 treatments started and a mortality rate of 0.04 per 1,000. Based on these findings, the American Thoracic Society and CDC advise that daily or twice weekly 2-month regimens of RZ should generally not be offered to persons with LTBI. For persons now on the RZ regimen, serum aminotransaminases and bilirubin should be measured at baseline and at 2, 4, 6, and 8 weeks of treatment, because the symptoms of liver injury began after the 4th week of therapy for most patients. Rifampin and pyrazinamide should continue to be used in multidrug regimens for the treatment of persons with active tuberculosis disease. The details about alternative single drug regimens (eg. isoniazid or rifampin) that are still accepted to treat LTBI in adults are outlined in a table.