Oh Chi Eun, Menzies Dick
Department of Pediatrics, Kosin University College of Medicine, Busan, Korea.
Respiratory Epidemiology and Clinical Research Unit, McGill International TB Centre, McGill University, Montreal, QC, Canada.
Clin Exp Pediatr. 2022 May;65(5):214-221. doi: 10.3345/cep.2021.01186. Epub 2021 Oct 29.
Diagnosing and treating latent tuberculosis infection (LTBI) is an important part of efforts to combat tuberculosis (TB). The Korean guidelines for TB published in 2020 recommend 2 LTBI regimens for children and adolescents: 9 months of daily isoniazid (9H) and 3 months of daily isoniazid plus rifampicin. Isoniazid for 6-12 months has been used to effectively treat LTBI in children for over 50 years. However, a long treatment period results in poor patient compliance. This review summarizes pediatric data on the treatment completion rate, safety, and efficacy of 4 months of daily rifampicin (4R) and evaluates the pharmacokinetics and pharmacodynamics of rifampicin in children. The 4R regimen has a higher treatment completion rate than the 9H regimen and equivalent safety in children. The efficacy of preventing TB is also consistent with that of 9H when summarizing reports published to date. A shorter treatment period could increase patient compliance and, therefore, prevent TB in more patients. By using an effective, safe, and highly compliant regimen for the treatment of children with LTBI, we would become one step closer to our goal of eradicating TB.
诊断和治疗潜伏性结核感染（LTBI）是抗击结核病（TB）工作的重要组成部分。2020年发布的韩国结核病指南为儿童和青少年推荐了两种LTBI治疗方案：每日服用异烟肼9个月（9H）以及每日服用异烟肼加利福平3个月。6至12个月的异烟肼治疗已被用于有效治疗儿童LTBI超过50年。然而，治疗周期过长会导致患者依从性差。本综述总结了关于每日服用利福平4个月（4R）的治疗完成率、安全性和疗效的儿科数据，并评估了利福平在儿童中的药代动力学和药效学。4R方案在儿童中的治疗完成率高于9H方案，且安全性相当。总结迄今为止发表的报告时，预防结核病的疗效也与9H方案一致。较短的治疗周期可以提高患者依从性，从而在更多患者中预防结核病。通过使用一种有效、安全且依从性高的方案来治疗LTBI儿童，我们将朝着消除结核病的目标又迈进一步。
