Intermittent versus daily therapy for treating tuberculosis in children

Twice- or thrice-weekly doses versus daily doses of drugs to treat tuberculosis in children

Anuradha Bose1, Soumik Kalita2, Winsley Rose3, Prathap Tharyan4

Christian Medical College, Department of Community Health, Vellore, India 
GlaxoSmithKline Consumer Healthcare, Family Nutrition, Gurgaon, Haryana, India
Christian Medical College, Department of Child Health, Vellore, India
Christian Medical College, South Asian Cochrane Network & Centre, Prof. BV Moses & ICMR Advanced Centre for Research & Training in Evidence Informed Health Care, Vellore, Tamil Nadu, India

Intermittent versus daily therapy for treating tuberculosis in children. Cochrane Database of Systematic Reviews 2014, Issue 1. Art. No.: CD007953.

To read the full review please follow this link: DOI: 10.1002/14651858.CD007953.pub2.

About half a million children are diagnosed with tuberculosis (TB) every year, usually infecting the lungs, but also other organs of the body, and can cause meningitis. Infection in children is relatively common, and so establishing effective drug regimens that are easy to take and monitor is important.

TB drug regimens are standardised globally, and include a combination of drugs given daily for six months. More than 95% of children are cured with this treatment. Giving anti-TB drugs twice- or thrice-weekly is more convenient to supervise than daily treatment but may not be as effective as daily treatment in curing children of TB. The World Health Organization currently recommends only daily treatments, but some national governments recommend twice- or thrice-weekly doses for children with TB.

In this Cochrane review, the review authors compared children given intermittent anti-TB treatment to those given daily treatment. They examined the evidence up to 30 May 2013 and included four randomized trials that compared twice-weekly treatment with daily doses of anti-TB drugs, but none evaluated thrice-weekly dosing. The four trials included 563 children aged five months to 15 years, not known to be resistant to TB drugs. The trials were published over 12 years ago and the regimens used are not those currently recommended.

The trials were small, and did not detect a difference between twice-weekly or daily treatment in the number of children who were cured, died, relapsed, reported taking most or all of the drugs, or had adverse effects. Whether regimens of drugs two or three times a week are as good as regimens with daily doses remains unclear, as the evidence base to date is small, and the regimens tested are not the same as currently currently recommended drug combinations.