Completion, Safety and Tolerability of Once-weekly Isoniazid and Rifapentine for Tuberculosis Infection by Children...

Treating patients for tuberculosis (TB) infection prevents future cases and transmission. Long treatment regimens have been associated with low completion rates. We describe a 1-decade experience with treating children and adolescents for TB infection (TBI) with 3 months of once-weekly doses of isoniazid and rifapentine (3HP).

This was a retrospective review (2014-2024) of 2 to <21 year olds who received 3HP under directly observed therapy for TBI. We abstracted demographic data, testing methods and treatment course information. Our primary outcome was treatment completion; our secondary outcome was adverse events (AEs).

Eight hundred two patients met inclusion criteria; 94.1% completed therapy. Completion rates were not associated with demographic data or testing methods. The most common reasons for not completing 3HP were AEs (23/802, 3%), moving out of the area (11, 1.4%) and pill burden (7, 0.9%). AEs resulting in failure to complete 3HP were rare. These included vomiting (15; 2 with elevated aspartate aminotransferase/alanine aminotransferase), abdominal pain (7, all with normal aspartate aminotransferase/alanine aminotransferase), rash (6), angioedema (4) and myalgias (2); 16/23 had >1 AE. Of the 23 with AEs, 20 began alternative regimens [rifampin (12), levofloxacin (5) and isoniazid (3)], and 17/20 (85%) completed TBI therapy.

Over 94% of children as young as 2 years of age completed 3HP for TBI, which is remarkable considering the large pill burden and lack of child-friendly formulations available in the United States. The only factor associated with treatment completion was the presence of an AE.