J Korean Med Sci.
2024 Feb 26;39(7):e97
https://doi.org/10.3346/jkms.2024.39.e97
eISSN 1598-6357·pISSN 1011-8934
Editorial
Infectious Diseases
Short Combination Treatment for
Latent Tuberculosis in Children
Hye-Kyung Cho
Department of Pediatrics, Ewha Womans University, College of Medicine, Seoul, Korea
► See the article “Current Status of Latent Tuberculosis Infection Treatment Among Pediatric Patients in
Korea: Prescription and Treatment Completion” in volume 39, number 7, e64.
Received: Feb 14, 2024 The treatment of latent tuberculosis infection (LTBI) is one of essential components for
Accepted: Feb 14, 2024 tuberculosis (TB) control, and especially important in young children. This is because when
Published online: Feb 21, 2024
young children are infected with TB, they are at a high risk of developing the disease within
Address for Correspondence: a shorter period of time after exposure, and of developing more serious diseases such as
Hye-Kyung Cho, MD, PhD disseminated TB or TB meningitis. They are also vulnerable because they are at potential risk of
Department of Pediatrics, Ewha Womans becoming TB patients in the future for longer periods of time throughout the rest of their lives.1
University, College of Medicine, 1071
Anyangcheon-ro, Yangcheon-gu, Seoul 07985,
Korea.
Among challenges in treating LTBI, the most significant issue is poor adherence to taking
Email: pdcho@ewha.ac.kr medication.2 Because LTBI is a condition without symptoms or signs, patients often have low
motivation due a lack of perceived efficacy and experience anxiety about treatment-associated
© 2024 The Korean Academy of Medical
adverse effects and stigmatization from taking medication, resulting in poor adherence.3
Sciences.
This is an Open Access article distributed
In the current issue of Journal of Korean Medical Science, Kim et al.4 compared the treatment
under the terms of the Creative Commons incompletion rates between 9 months of isoniazid treatment (9H) and 3 months of isoniazid
Attribution Non-Commercial License (https:// plus rifampicin (3HR) for latent tuberculosis infection in Korean children aged 11-18 years.
creativecommons.org/licenses/by-nc/4.0/) They reported better compliance in 3HR group than in 9H group, with the 9H regimen being
which permits unrestricted non-commercial the strongest factor associated with treatment incompletion.4 A multinational randomized
use, distribution, and reproduction in any
open-label clinical trial reported that the 3-month rifamycin-based combination regimen
medium, provided the original work is properly
cited. was more compliant than the 9H regimen and was as effective and safe as the 9H regimen.1
US Centers for Disease Control and Prevention recommends preferentially a combination of
ORCID iD weekly rifapentine and daily isoniazid for 3 months for children aged 2 years and older.5
Hye-Kyung Cho
https://orcid.org/0000-0003-0990-1350
There are several hurdles to recommending 3HR as the preferred treatment in Korea. Firstly,
Disclosure since pediatric syrup of rifampicin is not available in Korea, capsules or tablets must be
The author has no potential conflicts of split or crushed for preparation. However, pharmacists are reluctant to dispense it due to
interest to disclose.
concerns about discoloration of the dispensing tools. The introduction of pediatric syrups
may help overcome these obstacles. Additionally, one alternative could be reconsidering the
introduction of rifapentine for use in children, which was attempted and then aborted a few
years ago in Korea. Second, inducing resistance to rifampicin is another concern regarding
rifampicin-containing treatment for LTBI, as it is a crucial component of the TB treatment
regimen.6 However, it is noteworthy that the development of rifampicin resistance has
not been frequently observed in other clinical trials of therapy for LTBI, although studies
involving children have been very limited.6
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Short Combination Treatment for Latent Tuberculosis
Additionally, Kim et al.4 reported that physicians in primary hospitals, hospitals located in
non-metropolitan regions, and non-pediatric physicians require increased attention when
administering LTBI treatment to pediatric patients to ensure treatment completion, suggesting
that preferential use of 3HR could be an effective strategy to enhance treatment completion.
Sufficient patient (or caregiver)-medical provider communication is crucial to enhancing
adherence.3 A well-trained pediatrician with experience in communicating with pediatric
patients is ideal in LTBI management in children, but this may not always be available.
Therefore, it is essential for all doctors treating pediatric LTBI patients to clearly aware the
effectiveness and necessity of pediatric LTBI treatment and provide accurate information
about safety to reduce the anxiety of patients and their caregivers. In addition, it is suggested
for dedicated nurses, one of major elements of public–private mix (PPM) program for
tuberculosis in Korea,7 to provide more active support for the treatment of LTBI in children.
REFERENCES
1. Villarino ME, Scott NA, Weis SE, Weiner M, Conde MB, Jones B, et al. Treatment for preventing
tuberculosis in children and adolescents: a randomized clinical trial of a 3-month, 12-dose regimen of a
combination of rifapentine and isoniazid. JAMA Pediatr 2015;169(3):247-55. PUBMED | CROSSREF
2. Alsdurf H, Hill PC, Matteelli A, Getahun H, Menzies D. The cascade of care in diagnosis and treatment of
latent tuberculosis infection: a systematic review and meta-analysis. Lancet Infect Dis 2016;16(11):1269-78.
PUBMED | CROSSREF
3. Baryakova TH, Pogostin BH, Langer R, McHugh KJ. Overcoming barriers to patient adherence: the case for
developing innovative drug delivery systems. Nat Rev Drug Discov 2023;22(5):387-409. PUBMED | CROSSREF
4. Kim Y, Bae KS, Choi UY, Han SB, Kim JH. Current status of latent tuberculosis infection treatment among
pediatric patients in Korea: prescription and treatment completion. J Korean Med Sci 2024;39(7):e64.
CROSSREF
5. Centers for Disease Control and Prevention. TB Treatment for Children. https://www.cdc.gov/tb/topic/
treatment/children.htm. Updated 2016. Accessed February 13, 2024.
6. Batt J, Khan K. Responsible use of rifampin for the treatment of latent tuberculosis infection. CMAJ
2019;191(25):E678-9. PUBMED | CROSSREF
7. Yu S, Sohn H, Kim HY, Kim H, Oh KH, Kim HJ, et al. Evaluating the impact of the nationwide public-
private mix (PPM) program for tuberculosis under National Health Insurance in South Korea: A difference
in differences analysis. PLoS Med 2021;18(7):e1003717. PUBMED | CROSSREF
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