问题描述：
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Methods
Contacts had a tuberculin skin test (TST). LTBI among adults was defined as ≧5 mm of induration to five units of purified protein derivative (PPD), without radiographic or clinical evidence of active tuberculosis.(5) All exposed children were treated, regardless of TST results, because young children are at risk for developing rapid, disseminated tuberculosis.(5) Treatment is suspended if a TST 10 weeks later is alsonegative.(5)
Contacts with LTBI had a baseline history and physical examination. Pyrazinamide was prescribed according to patient’s weight at 15 mg/kg (maximum dose 2g) daily. Ri-fampin was prescribed at 10 mg/kg (maximum daily dose 600 mg) for children and 600 mg daily for all adults. Children received directly observed preventive therapy (DOPT); adultsself-administered treatment.
Adults received 2 weeks of medication per visit and were monitored with bi-weekly liver enzymes and clinical exam.(9) Because of limited data on RIF/PZA in children, there is no standard for monitoring.(13) The children underwent clinical assessment bi-weekly, but did not have liver enzymes mea-sured as frequently. Contacts (or parents) were counseled about possible hepatotoxicity.
Treatment completion was defined as self-report of 8 weeks of treatment (not number of doses) for adults, and 8 weeks of DOPT in children. Drug-induced hepatitis was defined according to guidelines,(9) as either serum aminotransferase elevation more than five times the upper limit of normal(＞200 U/L for both aspartate [AST] and alanine transaminases [ALT] in women and ＞200 U/L for AST and ＞225 U/L for ALT in men) or symptoms of hepatotoxicity (nausea, abdominal pain, jaundice, fatigue) accompanied by liver enzymes more than three times the upper limit of normal. RIF/PZA was suspended if drug-induced hepatitis was diagnosed.
Data were collected through chart abstraction and interviews with health department employees. Abstracted data included demographics, clinical information, comorbidities,other medication use, laboratory test results, types, dosages and duration of LTBI treatment, side effects, and completion rates. Alcohol consumption at baseline was categorized as yes or no because quantity was not always documented. Semi-structured interviews with four health department employees explored the benefits and limitations of short-course therapy.Cost analysis for an uncomplicated 2-month course of RIF/PZA versus 4 months of rifampin included medication costs and laboratory testing.
Adults who developed hepatotoxicity were compared to those who did not with Fisher exact tests for categorical variables and with Wilcoxon rank-sum tests for continuous variables. Data were analyzed using STATA 7.0 (Stata Corpo-ration, College Station TX, 2001).
Methods
Contacts had a tuberculin skin test (TST). LTBI among adults was defined as ≧5 mm of induration to five units of purified protein derivative (PPD), without radiographic or clinical evidence of active tuberculosis.(5) All exposed children were treated, regardless of TST results, because young children are at risk for developing rapid, disseminated tuberculosis.(5) Treatment is suspended if a TST 10 weeks later is alsonegative.(5)
Contacts with LTBI had a baseline history and physical examination. Pyrazinamide was prescribed according to patient’s weight at 15 mg/kg (maximum dose 2g) daily. Ri-fampin was prescribed at 10 mg/kg (maximum daily dose 600 mg) for children and 600 mg daily for all adults. Children received directly observed preventive therapy (DOPT); adultsself-administered treatment.
Adults received 2 weeks of medication per visit and were monitored with bi-weekly liver enzymes and clinical exam.(9) Because of limited data on RIF/PZA in children, there is no standard for monitoring.(13) The children underwent clinical assessment bi-weekly, but did not have liver enzymes mea-sured as frequently. Contacts (or parents) were counseled about possible hepatotoxicity.
Treatment completion was defined as self-report of 8 weeks of treatment (not number of doses) for adults, and 8 weeks of DOPT in children. Drug-induced hepatitis was defined according to guidelines,(9) as either serum aminotransferase elevation more than five times the upper limit of normal(＞200 U/L for both aspartate [AST] and alanine transaminases [ALT] in women and ＞200 U/L for AST and ＞225 U/L for ALT in men) or symptoms of hepatotoxicity (nausea, abdominal pain, jaundice, fatigue) accompanied by liver enzymes more than three times the upper limit of normal. RIF/PZA was suspended if drug-induced hepatitis was diagnosed.
Data were collected through chart abstraction and interviews with health department employees. Abstracted data included demographics, clinical information, comorbidities,other medication use, laboratory test results, types, dosages and duration of LTBI treatment, side effects, and completion rates. Alcohol consumption at baseline was categorized as yes or no because quantity was not always documented. Semi-structured interviews with four health department employees explored the benefits and limitations of short-course therapy.Cost analysis for an uncomplicated 2-month course of RIF/PZA versus 4 months of rifampin included medication costs and laboratory testing.
Adults who developed hepatotoxicity were compared to those who did not with Fisher exact tests for categorical variables and with Wilcoxon rank-sum tests for continuous variables. Data were analyzed using STATA 7.0 (Stata Corpo-ration, College Station TX, 2001).
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