RESUMEN
BACKGROUND AND OBJECTIVE: The effectiveness of the treatment of latent tuberculosis infection depends on its efficacy, the adherence to treatment and patient's risk of tuberculosis. The objective of this study was to evaluate the adherence to treatment with daily isoniazid for 9 months, its effectiviness and equivalent adherence with daily isoniazid for 6 months so that treatment can be as effective as with daily isoniazid for 9 months. PATIENTS AND METHOD: Cohort of 755 contacts of patients with lung confirmed tuberculosis with latent tuberculosis infection treated from 1986 to 2004, classified according to risk of tuberculosis disease into converters (high risk), frequent and non-frequent contacts. Adherence's rate for daily isoniazid for 9 months is evaluated according to percentage of treatment completion and effectiveness achieved is the number necessary to treat for preventing one tuberculosis case. Efficacy (reduction of morbidity) with isoniazid for 9 months: 93%, and with isoniazid for 6 months: 69%. RESULTS: Adherence's rate: 53/59 (89.9%; 95% confidence interval [CI], 82.1-97.5%) in converters; 305/380 (80.3%; 95% CI, 76.3-84.3%) in frequent contacts; and 205/211 (64.9%; 95% CI, 59.6-70.2%) in non-frequent contacts. The number necessary to treat with isoniazid for 9 months was 9 for converters, 16 for frequent contacts, and 79 for non-frequent contacts. Equivalent adherence for daily isoniazid for 6 months was 121% for converters, 108% for frequent contacts and 87.5% for non-frequent contacts. CONCLUSIONS: For latent tuberculosis infection, a 9-month-isoniazid treatment has the highest effectiveness in the converters and frequent contacts. Such high effectiveness is impossible to achieve with a daily 6-month-isoniazid regimen.
Asunto(s)
Antituberculosos/uso terapéutico , Isoniazida/uso terapéutico , Cooperación del Paciente , Tuberculosis Pulmonar/tratamiento farmacológico , Adolescente , Adulto , Anciano , Niño , Preescolar , Estudios de Cohortes , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Factores de TiempoRESUMEN
Fundamento y objetivo: La efectividad del tratamiento de la infección tuberculosa depende de su eficacia, la adherencia al tratamiento y el riesgo de enfermar. El objetivo del estudio ha sido evaluar la adherencia al tratamiento con isoniazida durante 9 meses, su efectividad y la adherencia equivalente para conseguir idéntica efectividad a la pauta de isoniazida durante 6 meses. Pacientes y método: Se incluyó en el estudio a contactos de pacientes con tuberculosis pulmonar a quienes se había diagnosticado de infección tuberculosa, clasificados de mayor a menor riesgo de desarrollar la enfermedad (conversores, contactos frecuentes y no frecuentes), y que entre 1986 y 2004 recibieron tratamiento con isoniazida durante 9 meses. Se determinaron la tasa de adherencia, es decir, el porcentaje que completó el tratamiento, y la efectividad como el número de pacientes que es necesario tratar para prevenir que uno desarrolle la enfermedad. La eficacia del tratamiento con isoniazida durante 9 meses es del 93% de reducción de la morbilidad, y la del tratamiento durante 6 meses, del 69%. Resultados: Se estudió a 755 contactos: 59 conversores, 380 contactos frecuentes y 316 contactos no frecuentes. En los primeros la tasa de adherencia fue del 89,9% (intervalo de confianza [IC] del 95%, 82,1-95,7%); en los segundos, del 80,3% (IC del 95%, 76,3-84,3%), y en los terceros, del 64,9% (IC del 95%, 59,6-70,2%). Con isoniazida durante 9 meses, el número de pacientes que era preciso tratar para prevenir que uno desarrollara la enfermedad fue de 9 en conversores, de 16 en contactos frecuentes y de 79 en contactos no frecuentes. Para la misma efectividad, la tasa de adherencia equivalente con isoniazida durante 6 meses sería del 121% en conversores, del 108% en contactos frecuentes y del 87,5% en contactos no frecuentes. Conclusiones: La mayor efectividad del tratamiento de la infección tuberculosa en conversores y contactos frecuentes se ha conseguido con una pauta de isoniazida durante 9 meses, efectividad no alcanzable con la pauta de 6 meses
Background and objective: The effectiveness of the treatment of latent tuberculosis infection depends on its efficacy, the adherence to treatment and patient's risk of tuberculosis. The objective of this study was to evaluate the adherence to treatment with daily isoniazid for 9 months, its effectiviness and equivalent adherence with daily isoniazid for 6 months so that treatment can be as effective as with daily isoniazid for 9 months. Patients and method: Cohort of 755 contacts of patients with lung confirmed tuberculosis with latent tuberculosis infection treated from 1986 to 2004, classified according to risk of tuberculosis disease into converters (high risk), frequent and non-frequent contacts. Adherence's rate for daily isoniazid for 9 months is evaluated according to percentage of treatment completion and effectiveness achieved is the number necessary to treat for preventing one tuberculosis case. Efficacy (reduction of morbidity) with isoniazid for 9 months: 93%, and with isoniazid for 6 months: 69%. Results: Adherence's rate: 53/59 (89.9%; 95% confidence interval [CI], 82.1-97.5%) in converters; 305/380 (80.3%; 95% CI, 76.3-84.3%) in frequent contacts; and 205/211 (64.9%; 95% CI, 59.6-70.2%) in non-frequent contacts. The number necessary to treat with isoniazid for 9 months was 9 for converters, 16 for frequent contacts, and 79 for non-frequent contacts. Equivalent adherence for daily isoniazid for 6 months was 121% for converters, 108% for frequent contacts and 87.5% for non-frequent contacts. Conclusions: For latent tuberculosis infection, a 9-month-isoniazid treatment has the highest effectiveness in the converters and frequent contacts. Such high effectiveness is impossible to achieve with a daily 6-month-isoniazid regimen