Treatment for LTBI in contacts of MDR-TB patients, Federated States of Micronesia, 2009-2012

• Published in: The international journal of tuberculosis and lung disease Vol. 18; no. 8; pp. 912 - 918
• Main Authors: Bamrah, S., Brostrom, R., Dorina, F., Setik, L., Song, R., Kawamura, L. M., Heetderks, A., Mase, S.
• Format: Journal Article
• Language: English
• Published: Paris International Union Against Tuberculosis and Lung Disease 01.08.2014; International Union against Tuberculosis and Lung Disease
• Subjects: Adolescent; Adult; Antitubercular Agents - adverse effects; Antitubercular Agents - therapeutic use; Bacterial diseases; Biological and medical sciences; Child; Child, Preschool; Cohort Studies; Contact Tracing; Directly Observed Therapy; Disease Outbreaks; Female; Fluoroquinolones - adverse effects; Fluoroquinolones - therapeutic use; Human bacterial diseases; Humans; Infant; Infectious diseases; Latent Tuberculosis - drug therapy; Latent Tuberculosis - epidemiology; Latent Tuberculosis - microbiology; Male; Medical sciences; Micronesia - epidemiology; Middle Aged; Multidrug-Resistant Tb; Mycobacterium Tuberculosis; Pneumology; Prospective Studies; Tb Prevention; Treatment Refusal; Tuberculosis and atypical mycobacterial infections; Tuberculosis, Multidrug-Resistant - drug therapy; Tuberculosis, Multidrug-Resistant - epidemiology; Young Adult; Micronesia; Oceania; Treatment resistance; Respiratory disease; multidrug-resistant TB; TB prevention; MDR tuberculosis; 2009; Prevention; Treatment; Mycobacterium tuberculosis; Mycobacteriales; Multiple resistance; Mycobacteriaceae; Bacteria; Actinomycetes; Antituberculous agent; Antibacterial agent; Public health
• ISSN: 1027-3719; 1815-7920
• DOI: 10.5588/ijtld.13.0028

SETTING: Few studies have shown the operational feasibility, safety, tolerability, or outcomes of multidrug-resistant latent tuberculous infection (MDR LTBI) treatment. After two simultaneous multidrug-resistant tuberculosis (MDR-TB) outbreaks in Chuuk, Federated States of Micronesia, infected contacts were offered a 12-month fluoroquinolone (FQ) based MDR LTBI treatment regimen.DESIGN: Between January 2009 and February 2012, 119 contacts of MDR-TB patients were followed using a prospective observational study design. After MDR-TB disease was excluded, 12 months of daily FQ-based preventive treatment of MDR LTBI was provided by directly observed therapy.RESULTS: Among the 119 infected contacts, 15 refused, while 104 began treatment for MDR LTBI. Of the 104 who initiated treatment, 93 (89%) completed treatment, while 4 contacts discontinued due to adverse effects. None of the 104 contacts who undertook MDR LTBI treatment of any duration developed MDR-TB disease; however, 3 of 15 contacts who refused and 15 unidentified contacts developed MDR-TB disease.CONCLUSION: Providing treatment for MDR LTBI can be accomplished in a resource-limited setting, and contributed to preventing MDR-TB disease. The Chuuk TB program implemented treatment of MDR LTBI with an 89% completion rate. The MDR LTBI regimens were safe and well tolerated, and no TB cases occurred among persons treated for MDR LTBI.