Simpler, shorter antibiotic regimen may prevent full-blown TB

A combination of antibiotics was more effective in preventing full-blown tuberculosis (TB) than the old regimen, according to a new study published in the July 7 issue of the New England Journal of Medicine.

Researchers with Johns Hopkins University School of Medicine and 2 universities in South Africa found that a high-dose pairing of 900 mg each of the newer antibiotic rifapentine and the traditional isoniazid once weekly for 3 months worked just as well or even better than 300 mg of isoniazid taken daily for 6 months or longer. The findings could prevent the development of full-blown TB in the millions of people worldwide who are infected with TB and those who are co-infected with HIV, the researchers said.

“This new, simpler treatment regimen with rifapentine and isoniazid is highly effective and could transform therapy for latent tuberculosis in both those co-infected with HIV and those not [co-infected],” said Richard Chaisson, MD, a professor of infectious diseases at the Johns Hopkins University School of Medicine and founder of the school’s Center for Tuberculosis Research.

The population that could be affected includes as many as 22 million people in sub-Saharan Africa who are already HIV-positive and at high risk of also contracting TB, as well as approximately 50,000 individuals in the United States who are HIV-positive and are at a high risk of developing TB.

In the latest study, researchers monitored 1,148 South African men and women co-infected with HIV for 3 to 6 years, to see whose TB infections stayed dormant or latent. Around 3.1% of patients developed active TB or died each year while taking the shorter drug regimen, compared to 3.6% in those using the traditional isoniazid regimen.