What are the options for treating latent TB infection in children?
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You are looking after a previously well, HIV-negative 4-year-old boy who has recently migrated to Australia from Sudan. He is BCG-immunised and reports no history of TB contact. His tuberculin skin test (TST) is positive (16 mm induration) and his chest x-ray (CXR) is normal. You diagnose latent tuberculosis infection (LTBI) and wonder what would be the best treatment regimen.
Structured clinical question
In a child with LTBI [patient], what is the best treatment regimen [intervention] taking into account four criteria: treatment compliance, drug adverse effects, treatment efficacy and cost [outcomes]?
Search strategy and outcome
Medline and EMBASE were searched using the Ovid interface (1974 to current date) in December 2012. The following keywords were used: (latent tuberculosis/[drug therapy, therapy]) OR (latent AND *tuberculosis/[diet therapy, drug therapy, surgery, therapy]). Limit set: English-language. Studies of LTBI treatment that included children aged less than 15 years were selected. Case reports, brief reports, studies of LTBI treatment for drug-resistant TB, studies including less than five children and studies of HIV-infected children were excluded. Of the 78 articles identified by the original search, 10 were relevant. The references of these publications were then reviewed and two additional articles were identified giving a total of 12 relevant studies (table 1). We contacted the corresponding authors of 10 of the articles and obtained further paediatric data from two (Li and Cook).
Children with LTBI have a significant risk of developing active TB without treatment, including those that have been BCG-immunised.1 Progression to active TB has been reported in up to 40% of infected infants.2
Recommendations for the treatment of LTBI in children vary: the Centers for Disease Control and Prevention recommend 9 months of isoniazid monotherapy3; the UK NICE …