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. 2000;1999(2):CD001363.
doi: 10.1002/14651858.CD001363.

Isoniazid for preventing tuberculosis in non-HIV infected persons

M J Smieja  1 , C A Marchetti, D J Cook, F M Smaill
Affiliations

Isoniazid for preventing tuberculosis in non-HIV infected persons

M J Smieja et al. Cochrane Database Syst Rev. 2000.

Abstract

Background: Although isoniazid (INH) is commonly used for treating tuberculosis (TB), it is also effective as preventive therapy.

Objectives: The objective of this review was to estimate the effect of 6 and 12 month courses of INH for preventing TB in HIV-negative people at increased risk of developing active TB.

Search strategy: We searched the Cochrane Infectious Diseases Group trials register, the Cochrane Controlled Trials Register, Medline, Embase and reference lists of articles. We hand-searched Science Citation Index and Index Medicus.

Selection criteria: Randomised trials of INH preventive therapy for 6 months or more compared with placebo. Follow-up for a minimum of 2 years. Trials enrolling patients with current or previously treated active TB, or with known HIV infection, were excluded. Criteria were applied by two reviewers independently.

Data collection and analysis: Trial quality was assessed by two reviewers independently, and data extracted by one reviewer using a standardized extraction form.

Main results: Eleven trials involving 73,375 patients were included. Trials were generally of high quality. Treatment with INH resulted in a relative risk (RR) of developing active TB of 0.40, (95% confidence interval ¿CI¿ 0.31 to 0.52), over two years or longer. There was no significant difference between 6 and 12 month courses (RR of 0.44, 95% CI 0.27 to 0.73 for six months, and 0.38, 95% CI 0.28 to 0.50 for 12 months). Preventive therapy reduced deaths from TB, but this effect was not seen for all cause mortality. INH was associated with hepatotoxicity in 0.36% of people on 6 months treatment and in 0.52% of people treated for 12 months.

Reviewer's conclusions: Isoniazid is effective for the prevention of active TB in diverse at-risk patients, and six and 12 month regimens have a similar effect.

PubMed Disclaimer

Conflict of interest statement

We certify that we have no affiliations with or involvement in any organisation or entity with a direct financial interest in the subject matter of the review (e.g. employment, consultancy, stock ownership, honoraria, expert testimony).

Figures

1.1
1.1. Analysis
Comparison 1 Isoniazid versus placebo, Outcome 1 Active tuberculosis.
1.2
1.2. Analysis
Comparison 1 Isoniazid versus placebo, Outcome 2 Extra‐pulmonary tuberculosis.
1.3
1.3. Analysis
Comparison 1 Isoniazid versus placebo, Outcome 3 TB deaths.
1.4
1.4. Analysis
Comparison 1 Isoniazid versus placebo, Outcome 4 Hepatitis.
1.5
1.5. Analysis
Comparison 1 Isoniazid versus placebo, Outcome 5 Hepatitis‐related deaths.
1.6
1.6. Analysis
Comparison 1 Isoniazid versus placebo, Outcome 6 Total deaths.
2.1
2.1. Analysis
Comparison 2 Isoniazid 6 vs 12 months, Outcome 1 Active tuberculosis.
2.2
2.2. Analysis
Comparison 2 Isoniazid 6 vs 12 months, Outcome 2 Hepatitis.
2.3
2.3. Analysis
Comparison 2 Isoniazid 6 vs 12 months, Outcome 3 Active tuberculosis in highly compliant.
3.1
3.1. Analysis
Comparison 3 INH 6 months vs placebo, Outcome 1 Active tuberculosis.
4.1
4.1. Analysis
Comparison 4 INH 12 months+ vs placebo, Outcome 1 Active tuberculosis.
5.1
5.1. Analysis
Comparison 5 High compliance (>80%) INH vs placebo, Outcome 1 Active tuberculosis.
See this image and copyright information in PMC

References

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