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EXCLUSIVE COCHRANE SUMMARY

Intermittent and daily therapy for tuberculosis in children

  • Comment

There is insufficient evidence to support one drug treatment regimen for children with tuberculosis over any other. Research is therefore needed to identify effective medication regimens

Citation: Stern C (2018) Intermittent and daily therapy for tuberculosis in children. Nursing Times; 110: 21, 19.

Author: Cindy Stern, Cochrane Nursing Care Field coordinator at the School of Translational Health Science, University of Adelaide, South Australia

Review question

This Cochrane review asked “What are the efficacy and safety of intermittent, short-course anti-tuberculosis treatment regimens compared with daily short-course anti-TB regimens for children with TB?” (Bose et al, 2014).

Nursing implications

The prevalence of childhood TB varies around the world; in low-income countries, it has been reported to be as high as 40% of the total TB burden (Marais and Schaaf, 2010; Nelson and Wells, 2004; Beyers et al, 1996).

National TB control programmes commonly recommend short-course treatments, either daily or intermittently (two or three times a week) for a period of

6-12 months; however, adherence can be low. A systematic review was therefore warranted to determine the differences between intermittent and daily short-course treatment regimens to inform policy and practice.

Study characteristics

Four randomised controlled trials were included in the review, containing a total of 563 participants.

Participants were children aged up to 15 years who had been diagnosed with TB using the World Health Organization diagnostic categories 1, 2 or 3.

The intervention of interest was intermittent (twice weekly or thrice weekly) short-course anti-TB regimens, which were compared with daily short-course anti-TB regimens. No other specifications were provided about the interventions and controls; however, all regimens had to contain rifampicin for the initial two months.

The primary outcome was cure (as defined by trial authors). Secondary outcomes included: death (from any cause during treatment or within one year after treatment completion); relapse (within 12 months after stopping treatment); and treatment adherence. Adverse effects were also considered.

The trials were published more than 12 years ago and the regimens used are not those recommended now. The trials were undertaken in South Africa, India and Turkey. In terms of drugs used, all studies used rifampicin and isoniazid, one used streptomycin and three used pyrazinamide. No trials were included that compared thrice-weekly anti-TB regimens with daily anti-TB regimens and none of the included studies used drug combinations or schedules currently recommended in practice.

The risk of bias of trials was considered low. The reviewers noted that trials were small, comparator regimens were not standard and there were variations across studies in terms of drug combinations used and duration of treatment. Meta-analysis was undertaken where possible

Summary of key evidence

Results indicated:

  • There was no difference detected between the number of patients cured between twice-weekly and daily anti-TB treatment groups (four trials; 465 participants);
  • There were also no differences detected for death (four trials), relapse (one trial) and treatment-limiting adverse events (four trials) between interventions and controls;
  • Treatment adherence was similar across trials (four trials);
  • No serious adverse effects were reported in any of the included studies.

Best-practice recommendations

Results from this systematic review suggest that there is insufficient evidence from RCTs to support one treatment regimen over the other. Additional high-quality RCTs are urgently required.

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