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

Journal article


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), pp. 117-138. https://doi.org/10.3121/cmr.2015.1272
AuthorsKasozi, Samuel, Clark, Justin and Doi, Suhail A. R.
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.

Keywordspulmonary tuberculosis; chemotherapy; intermittent; daily
Year2015
JournalClinical Medicine and Research
Journal citation13 (3-4), pp. 117-138
PublisherMarshfield Clinic
ISSN1539-4182
Digital Object Identifier (DOI)https://doi.org/10.3121/cmr.2015.1272
Scopus EID2-s2.0-84946507310
Research or scholarlyResearch
Page range117-138
Publisher's version
License
All rights reserved
File Access Level
Controlled
Output statusPublished
Publication dates
Online08 Jun 2015
Publication process dates
Accepted15 May 2015
Deposited09 Aug 2021
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https://acuresearchbank.acu.edu.au/item/8w90z/intermittent-versus-daily-pulmonary-tuberculosis-treatment-regimens-a-meta-analysis

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