TB Preventive Therapy for individuals exposed to drug-resistant tuberculosis: feasibility and safety of a community-based delivery of fluoroquinolone-containing preventive regimen.

Abstract

BACKGROUND\nObservational studies have demonstrated the effectiveness of a fluoroquinolone-based regimen to treat individuals exposed to or presumed to be infected with drug-resistant (DR)-TB. We sought to assess the feasibility of this approach in an urban setting in South Asia.\n\n\nMETHODS\nFrom February 2016 until March 2017, all household contacts of DR-TB patients enrolled at The Indus Hospital were screened for TB symptoms at home. Children 0-17 years, symptomatic adults and those with an immunocompromising condition (HIV, diabetes or malnutrition) were evaluated for TB disease. Contacts diagnosed with TB disease were started on treatment. Contacts without TB disease (i) younger than 5 years; (ii) between 5 and 17 years old with either a positive TST or an immunocompromising condition; or (iii) 18 years and older with an immunocompromising conditionwere offered six month treatment with a fluoroquinolone.\n\n\nRESULTS\nOne hundred households with 800 contacts were enrolled: 353 (44·1%) individuals age 17 years or younger with a median age of 19 years (IQR: 10-32); 423 (52·9%) were males. In total, 737 (92·1%) individuals were screened, of which eight were already on treatment for TB (1·1%), and another three (0·4%) contacts were diagnosed with TB disease and started on treatment. Of 215 eligible for infection treatment, 172 (80·0%) contacts initiated and 121 (70·3%) completed treatment. No TB disease nor significant adverse events were observed during 12 months of follow up in any group.\n\n\nCONCLUSIONS\nFluoroquinolone-based treatment for contacts with presumed DR-TB infection is feasible and well tolerated in a high TB burden setting.