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A randomised controlled trial of high-dose isoniazid adjuvant therapy for multidrug-resistant tuberculosis

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SETTING: Tertiary care hospital in Kanpur, India.

BACKGROUND: The need for a standardised treatment protocol for multidrug-resistant tuberculosis (MDR-TB) in resource-limited countries is being increasingly recognised.

OBJECTIVE: To assess the effectiveness of high-dose isoniazid (INH) (16–18 mg/kg) adjuvant to second-line therapy in documented cases of MDR-TB.

DESIGN: The present study is a double blind, randomised controlled trial with three treatment arms, high-dose INH, normal-dose INH and placebo, in addition to second-line drugs. Primary outcomes of the study were time to sputum culture conversion and proportion with sputum culture negative 6 months after treatment initiation. Secondary outcomes were radiological improvement at 1 year post treatment and development of toxicity.

RESULTS: After adjustment for potential confounders, subjects who received high-dose INH became sputum-negative 2.38 times (95%CI 1.45–3.91, P = 0.001) more rapidly than those who did not receive it, and had a 2.37 times (95%CI 1.46–3.84, P < 0.001) higher likelihood of being sputum-negative at 6 months. These subjects showed significantly better radiological improvement without an increased risk of INH toxicity.

CONCLUSION: In low-resource scenarios where a standardised therapeutic protocol is used for MDR-TB, the protocol can be significantly improved by including high-dose INH as an adjuvant.

Keywords: isoniazid; multidrug-resistant tuberculosis; randomised controlled trial

Document Type: Regular Paper

Affiliations: 1: Department of Tuberculosis & Respiratory Diseases, Ganesh Shankar Vidyarthi Memorial Medical College, Kanpur, India 2: Department of Tuberculosis & Respiratory Diseases, Ganesh Shankar Vidyarthi Memorial Medical College, Kanpur, India; and Lata Medical Research Foundation, Nagpur, India 3: Lata Medical Research Foundation, Nagpur, India

Publication date: February 1, 2008

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