Effectiveness of Preventive Therapy for Persons Exposed at Home to Drug-Resistant Tuberculosis, Karachi, Pakistan

• Published in: Emerging infectious diseases Vol. 27; no. 3; pp. 805 - 812
• Main Authors: Malik, Amyn A., Gandhi, Neel R., Lash, Timothy L., Cranmer, Lisa M., Omer, Saad B., Ahmed, Junaid F., Siddiqui, Sara, Amanullah, Farhana, Khan, Aamir J., Keshavjee, Salmaan, Hussain, Hamidah, Becerra, Mercedes C.
• Format: Journal Article
• Language: English
• Published: United States U.S. National Center for Infectious Diseases 01.03.2021; Centers for Disease Control and Prevention
• Subjects: Age; Antibiotics; Antitubercular Agents - therapeutic use; CME; contact investigation; Diabetes; Disease prevention; Dosage and administration; Drug resistance; drug-resistant tuberculosis infection; Effectiveness of Preventive Therapy for Persons Exposed at Home to Drug-Resistant Tuberculosis, Karachi, Pakistan; fluoroquinolone; Households; Humans; latent infection; Malnutrition; Medicine, Preventive; Megacities; Methods; Mycobacterium tuberculosis; Pakistan; Patients; Prevention; Preventive health services; preventive therapy; prophylaxis; Quinolone antibacterial agents; Quinolones; Risk factors; Tuberculosis; Tuberculosis, Multidrug-Resistant - drug therapy; Pakistan; Micronesia; Karachi Pakistan; Karachi; Pakistan; bacteria; antimicrobial resistance; fluoroquinolone; preventive therapy; contact investigation; drug-resistant tuberculosis infection; tuberculosis and other mycobacteria; latent infection; prophylaxis
• ISSN: 1080-6040; 1080-6059; 1080-6059
• DOI: 10.3201/eid2703.203916

In Karachi, Pakistan, a South Asian megacity with a high prevalence of tuberculosis (TB) and low HIV prevalence, we assessed the effectiveness of fluoroquinolone-based preventive therapy for drug-resistant (DR) TB exposure. During February 2016–March 2017, high-risk household contacts of DR TB patients began a 6-month course of preventive therapy with a fluoroquinolone-based, 2-drug regimen. We assessed effectiveness in this cohort by comparing the rate and risk for TB disease over 2 years to the rates and risks reported in the literature. Of 172 participants, TB occurred in 2 persons over 336 person-years of observation. TB disease incidence rate observed in the cohort was 6.0/1,000 person-years. The incidence rate ratio ranged from 0.29 (95% CI 0.04–1.3) to 0.50 (95% CI 0.06–2.8), with a pooled estimate of 0.35 (95% CI 0.14–0.87). Overall, fluoroquinolone-based preventive therapy for DR TB exposure reduced risk for TB disease by 65%.