New treatment option for latent tuberculosis

January 23, 2009

Patients who are infected with the latent form of tuberculosis (TB) show no symptoms and are not contagious, yet they pose the biggest challenge when it comes to controlling the disease. The latest study by Dr. Dick Menzies of the Research Institute of the McGill University Health Centre (MUHC) describes a new potential treatment for this particular form of TB. The paper based on this study was recently published in the Annals of Internal Medicine.

"Our results show that a four-month treatment with a drug called rifampin is better tolerated than the traditional nine-month treatment with a drug called isoniazid," explained Dr. Menzies. "The side effects with rifampin are much less frequent, particularly liver toxicity - which is the most serious risk of the traditional therapy with isoniazid. In addition patients are much more likely to complete this treatment - another big drawback to the nine month standard therapy."

Patients who currently receive a diagnosis of latent TB are treated for nine months with daily doses of isoniazid. Although effective, this treatment is very long and has major side effects on the liver. It is therefore common that patients do not complete treatment. Of course, this reduces the treatment's efficacy.

The new therapeutic option studied by Dr. Menzies lasts only four months and causes a lot less liver damage. Patients therefore adhere better to their treatment regimens, which is a critical first step towards ensuring the efficacy of the medication. This study was conducted on 847 patients in Canada, Brazil and Saudi Arabia. The results can therefore be generalized to a very broad population.

Currently, rifampin is most often used to treat the active form of TB. More in-depth studies will be necessary to test the effectiveness of this medication against latent TB, but the study researchers consider this treatment option to be very promising.

This study was funded by the Canadian Institutes of Health Research (CIHR) and the Fonds de la recherche en santé du Québec (FRSQ).

Dr. Dick Menzies is the Director of Respiratory Medicine at the MUHC and a researcher in the Respiratory Health Axis and Health Outcomes Axis at the Research Institute of the MUHC. He is also a Professor in Medicine, Epidemiology and Biostatistics - in the Faculty of Medicine of McGill University.

The Research Institute of the McGill University Health Centre (RI MUHC) is a world-renowned biomedical and health-care hospital research centre. Located in Montreal, Quebec, the institute is the research arm of the MUHC, the university health center affiliated with the Faculty of Medicine at McGill University. The institute supports over 600 researchers, nearly 1200 graduate and post-doctoral students and operates more than 300 laboratories devoted to a broad spectrum of fundamental and clinical research. The Research Institute operates at the forefront of knowledge, innovation and technology and is inextricably linked to the clinical programs of the MUHC, ensuring that patients benefit directly from the latest research-based knowledge.

McGill University Health Centre

---

---

	The White Plague: Tuberculosis, Man and Society by Jean Dubos (Author)
	Tuberculosis and Nontuberculous Mycobacterial Infections by David Schlossberg (Editor) Here's an up-to-date 4th Edition of the resource that discusses tuberculosis at a time when major outbreaks and drug-resistant strains of the disease are making headlines.
	The Forgotten Plague: How the Battle Against Tuberculosis Was Won - And Lost by Frank Ryan (Author) Ryan, a physician, offers a history of the cure for tuberculosis, including accounts of the people and scientists involved. The final chapter spells out a renewed threat in the congruence of AIDS and tuberculosis.
	Invincible Microbe: Tuberculosis and the Never-Ending Search for a Cure by Jim Murphy (Author), Alison Blank (Author) This is the story of a killer that has been striking people down for thousands of years: tuberculosis. After centuries of ineffective treatments, the microorganism that causes TB was identified, and the cure was thought to be within reach—but drug-resistant varieties continue to plague and panic the human race. The “biography” of this deadly germ, an account of the diagnosis, treatment, and “cure” of the disease over time, and the social history of an illness that could strike anywhere but was most prevalent among the poor are woven together in an engrossing, carefully researched narrative. Bibliography, source notes, index.
	Tuberculosis: A Comprehensive Clinical Reference, 1e by H. Simon Schaaf MBChB(Stellenbosch) MMed Paed(Stellenbosch) DCM(Stellenbosch) MD Paed(Stellenbosch) (Editor), Alimuddin Zumla BSc.MBChB.MSc.PhD.FRCP(Lond).FRCP(Edin).FRCPath(UK) (Editor) This book provides all the vital information you need to know about tuberculosis, especially in the face of drug-resistant strains of the disease. Coverage includes which patient populations face an elevated risk of infection, as well as which therapies are appropriate and how to correctly monitor ongoing treatment so that patients are cured. Properly administer screening tests, interpret their results, and identify manifestations of the disease, with authoritative guidance from expert clinicians from around the world.Discusses screening tests for tuberculosis so you can interpret their results and identify not only common manifestations of the disease, but also those that are comparatively rare-such as tuberculosis in pregnant women. Covers all clinical aspects of tuberculosis in...
	A Child of Sanitariums: A Memoir of Tuberculosis Survival and Lifelong Disability by Gloria Paris (Author) This dramatic memoir recounts one woman's experience with skeletal tuberculosis, which she contracted at the age of five in the 1930s. It recounts her next nine years living in tuberculosis sanatoriums where she underwent many treatments for the disease and was finally released when she was 14. Despite her subsequent disablement, she went on to marry and have three children, work as a micro-biologist, perform as a comedienne, and serve as an advocate for minority groups. By turns deeply affecting and hilarious, this memoir provides a glimpse into a still-dangerous disease and is a testament to the power of human perseverance and hope.
	The Return of the White Plague: Global Poverty and the "New" Tuberculosis by Matthew Gandy (Editor), Alimuddin Zumla (Editor) A global health catastrophe threatens to undermine all efforts to eradicate poverty and human suffering.The dramatic increase since the 1980s in the global prevalence of tuberculosis, a disease destined as recently as thirty years ago for complete eradication, is a story of medical failure. A pandemic whose geography defies simple categorization, it ranges from schools in the UK to prisons in Russia, from refugee camps in central Africa to affluent suburbs in North America. The 'new' tuberculosis is derived from a combination of different developments such as collapsing health-care services, shifting patterns of poverty and inequality, the spread of HIV, and the emergence of virulent drug-resistant strains. This collection provides an international survey of current thought on the spread...
	Captain of Death: The Story of Tuberculosis by Thomas M. Daniel (Author) The dramatic story of tuberculosis is told here in a straightforward and accessible style. It presents the stories of persons connected with the disease, either as victims, or as those who made contributions to our knowledge of it; in addition to these personal accounts, the book unfolds the history and explains the pathogenesis of TB. The re-emergence of tuberculosis as a major American public health hazard has focused much attention on this ancient disease. This book offers a comprehensive account of the disease from prehistoric times through to the present day, detailing the attempts to eradicate it completely. Its four separate sections (the spread of tuberculosis; its infectious nature; susceptibility to it; and methods of treatment) are linked through the device of presenting...
	Tuberculosis TUBERCULOSIS Last updated 2/25/2012 Table of Contents - Background, Statistics, Epidemiology - Method of Spread - Pathophysiology - History - Risk factors - Differential Diagnosis - Physical Exam - Workup - Treatment - More to come
	The Bioarchaeology of Tuberculosis: A Global View on a Reemerging Disease by CHARLOTTE ROBERTS (Author), JANE BUIKSTRA (Author) Though apparently in decline during the first half of the 20th century, tuberculosis has reawakened in both developed and developing countries, particularly among susceptible populations with immunodeficiency disorders.