Intermittent versus daily pulmonary tuberculosis treatment regimens: a meta-analysis

Kasozi, Samuel, Clark, Justin and Doi, Suhail A. R. (2015) Intermittent versus daily pulmonary tuberculosis treatment regimens: a meta-analysis. Clinical Medicine and Research, 13 3-4: 117-138. doi:10.3121/cmr.2015.1272


Author Kasozi, Samuel
Clark, Justin
Doi, Suhail A. R.
Title Intermittent versus daily pulmonary tuberculosis treatment regimens: a meta-analysis
Journal name Clinical Medicine and Research   Check publisher's open access policy
ISSN 1554-6179
1539-4182
Publication date 2015-12-01
Sub-type Article (original research)
DOI 10.3121/cmr.2015.1272
Open Access Status Not Open Access
Volume 13
Issue 3-4
Start page 117
End page 138
Total pages 22
Place of publication Marshfield, WI, United States
Publisher Marshfield Clinic
Language eng
Formatted abstract
Background:  Several systematic reviews suggest that intermittent pulmonary tuberculosis (TB) chemotherapy is effective, but intensity (daily versus intermittent) and duration of rifampicin use (intensive phase only versus both phases) have not been distinguished. In addition, the various outcomes (success, failure, relapse, and default) have only selectively been evaluated.

Methods:  We conducted a meta-analysis of proportions using all four outcomes as multi-category proportions to examine the effectiveness of WHO category 1 TB treatment regimens. Database searches of studies reporting treatment outcomes of HIV negative subjects were included and stratified by intensity of therapy and duration of rifampicin therapy. Using a bias-adjusted statistical model, we pooled proportions of the four treatment outcome categories using a method that handles multi-category proportions.

Results:  A total of 27 studies comprising of 48 data sets with 10,624 participants were studied. Overall, treatment success was similar among patients treated with intermittent (I/I) (88%) (95% CI, 81–92) and daily (D/D) (90%) (95% CI, 84–95) regimens. Default was significantly less with I/I (0%) (95% CI, 0–2) compared to D/D regimens (5%) (95% CI, 1–9). Nevertheless, I/I relapse rates (7%) (95% CI, 3–11) were higher than D/D relapse rates (1%) (95% CI, 0–3).

Conclusion:  Treatment regimens that are offered completely intermittently versus completely daily are associated with a trade-off between treatment relapse and treatment default. There is a possibility that I/I regimens can be improved by increasing treatment duration, and this needs to be urgently addressed by future studies.
Keyword Chemotherapy
Daily
Intermittent
Pulmonary tuberculosis
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2016 Collection
School of Public Health Publications
 
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