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Fully intermittent dosing with drugs for treating tuberculosis in adults

  1. Henry C Mwandumba1,*,
  2. Stephen B Squire2

Editorial Group: Cochrane Infectious Diseases Group

Published Online: 21 JAN 2009

Assessed as up-to-date: 5 SEP 2005

DOI: 10.1002/14651858.CD000970

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How to Cite

Mwandumba HC, Squire SB. Fully intermittent dosing with drugs for treating tuberculosis in adults. Cochrane Database of Systematic Reviews 2001, Issue 4. Art. No.: CD000970. DOI: 10.1002/14651858.CD000970.

Author Information

  1. 1

    University of Liverpool, Department of Pharmacology & Therapeutics, Liverpool, Merseyside, UK

  2. 2

    Liverpool School of Tropical Medicine, Clinical Group, Liverpool, Merseyside, UK

*Henry C Mwandumba, Department of Pharmacology & Therapeutics, University of Liverpool, Ashton Street, Liverpool, Merseyside, L69 3GE, UK. H.C.Mwandumba@liv.ac.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 21 JAN 2009

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Characteristics of included studies [ordered by study ID]
Hong Kong 1981
MethodsRandomized controlled trial, allocation method not stated
ParticipantsAdult attenders at chest clinic with smear positive pulmonary tuberculosis
InterventionsRandomized to 5 regimens

Only one comparison relevant to this review:

Group 1: Daily isoniazid, rifampicin, pyrazinamide, and ethambutol for 6 months
Group 2: Same drugs as in group 1 but given 3 times a week for 6 months
OutcomesMicrobiological cure, mortality, sterility, recurrence, resistance, adherence, and toxicity
NotesNo human immunodeficiency virus (HIV) positive participants (pre-HIV epidemic)


 
Characteristics of excluded studies [ordered by study ID]
StudyReason for exclusion
Brazil 1989Long duration of initial daily therapy for the intermittent group (2 months).
Hong Kong 1974Long duration of treatment (more than 9 months).
Hong Kong 1982This is the same study as the one included (Hong Kong 1981) but details a longer follow-up period (18 months after stopping treatment). In our review relapse of disease has been defined within the context of a 12 month follow-up period after stopping treatment, so further episodes of recurrent disease beyond 12 months do not add to the analysis.
Hong Kong 1987This is the same study as the one included (Hong Kong 1981) but detailing longer follow-up to 5 years. Once again it is difficult to classify episodes of disease in this time period as arising because of reinfection or relapse.
India 1990Conducted in children aged 1 to 15 years.

Included participants with pulmonary, lymph node, and disseminated tuberculosis.

Daily treatment was for 2 months followed by 4 months of twice weekly therapy.
Korea 1988Long duration of treatment (more than 9 months).
South Africa 2000Study conducted in children with all forms of intrathoracic tuberculosis.

Tuberculosis was confirmed in 4%, was probable in 94%, and was suspected in 2% of the patients.


 
Comparison 1. Thrice weekly tuberculosis treatment versus daily treatment
Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size
 1 Cure1399Risk Ratio (M-H, Fixed, 95% CI)0.99 [0.90, 1.10]
    1.1 Drug sensitive pretreatment
1342Risk Ratio (M-H, Fixed, 95% CI)Not estimable
    1.2 Drug resistant pretreatment
157Risk Ratio (M-H, Fixed, 95% CI)0.99 [0.90, 1.10]
 2 Death1399Risk Ratio (M-H, Fixed, 95% CI)3.81 [0.16, 89.67]
    2.1 Drug sensitive pretreatment
1342Risk Ratio (M-H, Fixed, 95% CI)Not estimable
    2.2 Drug resistant pretreatment
157Risk Ratio (M-H, Fixed, 95% CI)3.81 [0.16, 89.67]
 3 Recurrence1378Risk Ratio (M-H, Fixed, 95% CI)4.00 [0.66, 24.10]
    3.1 Drug sensitive pretreatment
1325Risk Ratio (M-H, Fixed, 95% CI)3.93 [0.44, 34.75]
    3.2 Drug resistant pretreatment
153Risk Ratio (M-H, Fixed, 95% CI)4.17 [0.18, 97.93]
 4 Resistance1399Risk Ratio (M-H, Fixed, 95% CI)Not estimable
    4.1 Drug sensitive pretreatment
1342Risk Ratio (M-H, Fixed, 95% CI)Not estimable
    4.2 Drug resistant pretreatment
157Risk Ratio (M-H, Fixed, 95% CI)Not estimable
 5 Adherence1399Risk Ratio (M-H, Fixed, 95% CI)0.99 [0.90, 1.10]
    5.1 Drug sensitive pretreatment
1342Risk Ratio (M-H, Fixed, 95% CI)Not estimable
    5.2 Drug resistant pretreatment
157Risk Ratio (M-H, Fixed, 95% CI)0.99 [0.90, 1.10]
 6 Toxicity1480Risk Ratio (M-H, Fixed, 95% CI)0.99 [0.62, 1.59]
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