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Rifampicin resistance after treatment for latent tuberculous infection: a systematic review and meta-analysis
S den Boon1, A Matteelli2, H Getahun2
1Independent consultant, Geneva, Switzerland.
Setting:
Treatment for latent tuberculous infection (LTBI) reduces the risk of tuberculosis (TB) disease. Shorter, rifamycin-containing regimens have been shown to be as effective as 6 months of isoniazid and superior with regard to safety and completion rate. It is unknown whether preventive therapy with rifamycins increases resistance to the drugs used.
Objective:
To determine whether treatment for LTBI with rifamycin-containing regimens leads to significant development of resistance against rifamycins.
Design:
Systematic review and meta-analysis.
Results:
We included six randomised-controlled trials of rifamycin-containing regimens for LTBI treatment that reported drug resistance. There was no statistically significant increased risk of rifamycin resistance after LTBI treatment with rifamycin-containing regimens compared to non-rifamycin-containing regimens (RR 3.45, 95%CI 0.72-16.56; P = 0.12) or placebo (RR 0.20, 95%CI 0.02-1.66; P = 0.13).
Conclusion:
Preventive treatment with rifamycin-containing regimens does not significantly increase rifamycin resistance. Programmatic management of LTBI requires the creation of sound surveillance systems to monitor drug resistance.
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