Safety and side effects of rifampin vs. isoniazid in children

A multinational study explored the effect of rifampin in children who develop latent infection with Mycobacterium tuberculosis, which makes them susceptible to potentially deadly TB. The recommended first-line treatment is isoniazid, but the 9-month treatment course has a low adherence rate and a risk of hepatotoxicity.

A multinational study explored the effect of rifampin in children who develop latent infection with Mycobacterium tuberculosis, which makes them susceptible to potentially deadly TB. The recommended first-line treatment is isoniazid, but the 9-month treatment course has a low adherence rate and a risk of hepatotoxicity. Rifampin has proven to be a safer choice in adults; however, the efficacy among pediatric patients remained unknown. To investigate, researchers analyzed outcomes in 829 patients younger than age 18 years and presenting with M. tuberculosis infection. Participants in the open-label trial were randomly allocated to standard treatment with isoniazid or to 4 months of therapy with rifampin. Of 407 children in the isoniazid group, 76.4% completed the treatment; but the adherence rate jumped to 85.3% among the 422 children in the rifampin group. The rate of adverse events between the two sets of patients was comparable; and the incidence of active TB was also similar at 2 and 0 cases, respectively. Based on the findings, the investigators consider rifampin and isoniazid similar in terms of safety and efficacy, but pediatric patients with M. tuberculosis were more likely to finish the treatment with the shorter-course rifampin.