Latent tuberculosis therapy prevents the development of an active form of the disease. Such prophylactic therapy is recommended for patients with suspected infection (with a positive cutaneous tuberculin reaction) and patients at high risk of developing active tuberculosis. The standard regimen is to administer isoniazid (H) for 6 to 12 months. Due to the low compliance due to the duration of treatment, shorter courses have been offered. In 1988, the British Thoracic Society recommended a three-month alternative treatment for rifampicin and isoniazid (H + R), although the evidence base for this recommendation is limited.

Spanish researchers conducted a meta-analysis of studies comparing the efficacy and safety of a three-month H + R regimen and treatment with isoniazid for more than six months. with latent tuberculosis.

The meta-analysis included 5 randomized controlled trials (one study in Uganda and Hong Kong and 3 in Spain), including 1,926 adult patients. Three studies included patients with HIV infection (n = 1390) and two studies included patients who were not infected with HIV or who had not been tested for HIV (n = 536). The duration of standard isoniazid treatment in 3 studies was 6 months, in the other 3 studies - more than 6 months. 954 patients received standard treatment (H), 972 received alternative treatment (H + R). The mean follow-up period was 13 to 37 months.

The development of active tuberculosis was observed in 41 (4.2%) patients receiving H + R, and in 39 (4.1%) in group H (group risk difference [RGR] 0%; interval 95% confidence level [CI] - 1 -2%). Serious adverse reactions requiring discontinuation of therapy were observed in 48 (4.9%) patients receiving short-term therapy and in 46 (4.8%) patients receiving standard therapy, while the differences were not also not statistically significant (RGR - 1%; 95% CI - 7-5%). Mortality data have been presented in three books. There was no statistically significant difference in the mortality rate between the two groups: 67 (9.5%) patients died in the alternative therapy group, 71 (10.4%) patients in the therapy group standard (RGR 1%; CI 95% from - 4 to 2%).

Thus, the same efficacy and safety of a three-month isoniazid treatment in combination with rifampicin and a 6 to 12 month isoniazid treatment in the treatment of latent tuberculosis have been demonstrated. When choosing one of the treatment regimens, it is necessary to be guided by the expected compliance, cost, availability of drugs and local data on the resistance level of mycobacteria.