Isoniazid vs. rifampin for latent tuberculosis infection in jail inmates: toxicity and adherence

Abstract

This open-label randomized trial compared isoniazid (9 months) to rifampin (4 months) on toxicity and completion in a jailed population with latent tuberculosis infection. Rifampin resulted in fewer elevated liver function tests (risk ratio [RR] 0.39, 95% confidence interval [CI] [0.18, 0.86]) and less toxicity requiring medication withdrawal (RR 0.51, 95% CI [0.13, 2.01]), although one participant receiving rifampin experienced an allergic reaction. Completion was achieved for 33% receiving rifampin compared to 26% receiving isoniazid (p = .10). With careful monitoring rifampin is a safe and less toxic regimen and appears to be a reasonable alternative because of its shorter duration, allowing more people to complete treatment behind bars. Therapy completion in released inmates is unacceptably low and ensuring follow-up after discharge must be part of a decision to treat.

Trial registration: ClinicalTrials.gov NCT00128206.

Conflict of interest statement

Declaration of Conflicting Interests

The authors disclosed no conflicts of interest with respect to the authorship and/or publication of this article. For information about JCHC’s disclosure policy, please see the Self-Study Exam.

Figures

Figure 1

Flow diagram of the study population.

Figure 2

Completion of therapy by study group and disposition: product-limit survival function estimates of treatment completion. 1 = INH participants who never left jail (Jail); 2 = RIF participants who never left jail (Jail); 3 = INH participants released on medication (Community); 4 = RIF participants released on medication (Community); 5 = INH participants deported or delivered to another correctional facility (Deported/Transferred); 6 = RIF participants deported or delivered to another correctional facility (Deported/Transferred); + Censored observation (medication completion). INH = isoniazid; RIF = rifampin.