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Free Content Rifampicin plus pyrazinamide versus isoniazid for treating latent tuberculosis infection: a meta-analysis [Review Article]

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SETTING: Six trials from Haiti, Mexico, the USA, Brazil, Spain, Zambia and Hong Kong.

OBJECTIVE: To evaluate the efficacy and safety of rifampicin plus pyrazinamide (RZ) vs. isoniazid (INH) for the prevention of tuberculosis (TB) among persons with or without human immunodeficiency virus (HIV) infection.

DESIGN: Meta-analysis of randomised controlled trials (RCTs) and quasi-RCTs that compared RZ for 2–3 months with INH for 6–12 months. Endpoints were development of active TB, severe adverse effects and death. Treatment effects were summarised as risk difference (RD) with 95% confidence intervals (CI).

RESULTS: Three trials conducted in HIV-infected patients and three trials conducted in non-HIV-infected persons were identified. The rates of TB in the RZ group were similar to those in the INH group, whether the subjects were HIV-infected or not (HIV-infected patients: pooled RD = 0%, 95%CI −1–2, P = 0.89; non-HIV-infected persons: pooled RD = 0%, 95%CI −2–1, P = 0.55). There was no difference in mortality between the two treatment groups (HIV-infected patients: pooled RD = −1%, 95%CI −4–2, P = 0.53; non-HIV-infected persons: pooled RD = 0%, 95%CI −1–1, P = 1.00). However, both subgroup analyses showed that a higher incidence of all severe adverse events was associated with 2RZ than INH among non-HIV-infected persons (RD = 29%, 95%CI 13–46, P = 0.0005 vs. RD = 7%, 95%CI 4–10, P < 0.0001).

CONCLUSION: RZ is equivalent to INH in terms of efficacy and mortality in the treatment of latent tuberculosis infection. However, this regimen increases the risk of severe adverse effects compared with INH in non-HIV-infected persons.
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Keywords: isoniazid; meta-analysis; pyrazinamide; rifampicin; tuberculosis

Document Type: Review Article

Affiliations: Chinese Evidence-Based Medicine Centre, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China

Publication date: 2006-10-01

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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