Effectiveness and safety of the available preventive tuberculosis treatment regimens for children and adolescents: systematic review and network meta-analysis - Summary - MDSpire
To assess the effectiveness and safety of available tuberculosis treatment regimens for children and adolescents exposed to drug-susceptible TB.
Approach:
Systematic Review and Network Meta-Analysis: The review included randomized controlled trials (RCTs) of children and adolescents under 18 years with TB infection or exposure, evaluating treatment regimens for effectiveness and safety.
Key Findings:
4 months of isoniazid and rifampicin (4HR) was associated with fewer active TB cases compared to 9 months of isoniazid (9H) at 1 year (RR 0.49 (95% CI 0.32 to 0.76)), 2 years, and 5 years of follow-up.
Treatment adherence was higher with isoniazid + rifapentine for 3 months (3HP) (RR 1.09 (95% CI 1.03 to 1.15)), 4HR (RR 1.07 (95% CI 1.01 to 1.14)), and rifampicin for 4 months (4R) (RR 1.12 (95% CI 1.05 to 1.20)) compared to 9H.
Adverse reactions were more likely with 3HP than with 4HR (OR 4.56 (95% CI 1.22 to 16.96)) or 4R (OR 6.37 (95% CI 2.11 to 19.19)), while 4R had fewer adverse reactions compared to 9H (OR 0.34 (95% CI 0.20 to 0.58)).
Interpretation:
The findings suggest that short-course regimens may improve adherence and reduce active TB incidence in pediatric populations compared to traditional long-course therapy.
Limitations:
The network geometries contained open and disconnected loops, which may affect the robustness of the findings.
Reporting of adverse reactions varied substantially across studies.
Conclusion:
['Short-course regimens such as 3HP, 4HR, and 4R may achieve better adherence and lower active TB incidence compared to 9H.']
Investigators linked distinct odor patterns to life stage, sex, and skin microbes, while limited longitudinal evidence leaves their clinical utility uncertain.
