Preventive therapy for latent tuberculosis infection—the promise and the challenges

G. J. Fox, C. C. Dobler, B. J. Marais, J. T. Denholm

Research output: Contribution to journalArticleResearchpeer-review

28 Citations (Scopus)

Abstract

Around one third of the world's population may harbour latent tuberculosis infection (LTBI), an asymptomatic immunological state that confers a heightened risk of subsequently developing tuberculosis (TB). Effectively treating LTBI will be essential if the End TB Strategy is to be realized. This review evaluates the evidence in relation to the effectiveness of preventive antibiotic therapy to treat LTBI due to both drug-susceptible and drug-resistant bacteria. Current national and international preventive therapy guidelines are summarized, as well as ongoing randomized trials evaluating regimens to prevent drug-resistant TB. Populations that may benefit most from screening and treatment for LTBI include close contacts of patients with TB (particularly children under 5 years of age) and individuals with substantial immunological impairment. The risks and benefits of treatment must be carefully balanced for each individual. Electronic decision support tools offer one way in which clinicians can help patients to make informed decisions. Modelling studies indicate that the expanded use of preventive therapy will be essential to achieving substantial reductions in the global TB burden. However, the widespread scale-up of screening and treatment will require careful consideration of cost-effectiveness, while ensuring the drivers of ongoing disease transmission are also addressed.

Original languageEnglish
Pages (from-to)68-76
Number of pages9
JournalInternational Journal of Infectious Diseases
Volume56
DOIs
Publication statusPublished - 1 Mar 2017
Externally publishedYes

Fingerprint

Latent Tuberculosis
Tuberculosis
Therapeutics
Asymptomatic Diseases
Multidrug-Resistant Tuberculosis
Pharmaceutical Preparations
Population
Cost-Benefit Analysis
Guidelines
Anti-Bacterial Agents
Bacteria

Cite this

@article{e70603ec484c4fd18e036e8ac7d9252a,
title = "Preventive therapy for latent tuberculosis infection—the promise and the challenges",
abstract = "Around one third of the world's population may harbour latent tuberculosis infection (LTBI), an asymptomatic immunological state that confers a heightened risk of subsequently developing tuberculosis (TB). Effectively treating LTBI will be essential if the End TB Strategy is to be realized. This review evaluates the evidence in relation to the effectiveness of preventive antibiotic therapy to treat LTBI due to both drug-susceptible and drug-resistant bacteria. Current national and international preventive therapy guidelines are summarized, as well as ongoing randomized trials evaluating regimens to prevent drug-resistant TB. Populations that may benefit most from screening and treatment for LTBI include close contacts of patients with TB (particularly children under 5 years of age) and individuals with substantial immunological impairment. The risks and benefits of treatment must be carefully balanced for each individual. Electronic decision support tools offer one way in which clinicians can help patients to make informed decisions. Modelling studies indicate that the expanded use of preventive therapy will be essential to achieving substantial reductions in the global TB burden. However, the widespread scale-up of screening and treatment will require careful consideration of cost-effectiveness, while ensuring the drivers of ongoing disease transmission are also addressed.",
author = "Fox, {G. J.} and Dobler, {C. C.} and Marais, {B. J.} and Denholm, {J. T.}",
year = "2017",
month = "3",
day = "1",
doi = "10.1016/j.ijid.2016.11.006",
language = "English",
volume = "56",
pages = "68--76",
journal = "International Journal of Infectious Diseases",
issn = "1201-9712",
publisher = "Elsevier",

}

Preventive therapy for latent tuberculosis infection—the promise and the challenges. / Fox, G. J.; Dobler, C. C.; Marais, B. J.; Denholm, J. T.

In: International Journal of Infectious Diseases, Vol. 56, 01.03.2017, p. 68-76.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Preventive therapy for latent tuberculosis infection—the promise and the challenges

AU - Fox, G. J.

AU - Dobler, C. C.

AU - Marais, B. J.

AU - Denholm, J. T.

PY - 2017/3/1

Y1 - 2017/3/1

N2 - Around one third of the world's population may harbour latent tuberculosis infection (LTBI), an asymptomatic immunological state that confers a heightened risk of subsequently developing tuberculosis (TB). Effectively treating LTBI will be essential if the End TB Strategy is to be realized. This review evaluates the evidence in relation to the effectiveness of preventive antibiotic therapy to treat LTBI due to both drug-susceptible and drug-resistant bacteria. Current national and international preventive therapy guidelines are summarized, as well as ongoing randomized trials evaluating regimens to prevent drug-resistant TB. Populations that may benefit most from screening and treatment for LTBI include close contacts of patients with TB (particularly children under 5 years of age) and individuals with substantial immunological impairment. The risks and benefits of treatment must be carefully balanced for each individual. Electronic decision support tools offer one way in which clinicians can help patients to make informed decisions. Modelling studies indicate that the expanded use of preventive therapy will be essential to achieving substantial reductions in the global TB burden. However, the widespread scale-up of screening and treatment will require careful consideration of cost-effectiveness, while ensuring the drivers of ongoing disease transmission are also addressed.

AB - Around one third of the world's population may harbour latent tuberculosis infection (LTBI), an asymptomatic immunological state that confers a heightened risk of subsequently developing tuberculosis (TB). Effectively treating LTBI will be essential if the End TB Strategy is to be realized. This review evaluates the evidence in relation to the effectiveness of preventive antibiotic therapy to treat LTBI due to both drug-susceptible and drug-resistant bacteria. Current national and international preventive therapy guidelines are summarized, as well as ongoing randomized trials evaluating regimens to prevent drug-resistant TB. Populations that may benefit most from screening and treatment for LTBI include close contacts of patients with TB (particularly children under 5 years of age) and individuals with substantial immunological impairment. The risks and benefits of treatment must be carefully balanced for each individual. Electronic decision support tools offer one way in which clinicians can help patients to make informed decisions. Modelling studies indicate that the expanded use of preventive therapy will be essential to achieving substantial reductions in the global TB burden. However, the widespread scale-up of screening and treatment will require careful consideration of cost-effectiveness, while ensuring the drivers of ongoing disease transmission are also addressed.

UR - http://www.scopus.com/inward/record.url?scp=85009813187&partnerID=8YFLogxK

U2 - 10.1016/j.ijid.2016.11.006

DO - 10.1016/j.ijid.2016.11.006

M3 - Article

VL - 56

SP - 68

EP - 76

JO - International Journal of Infectious Diseases

JF - International Journal of Infectious Diseases

SN - 1201-9712

ER -