Evaluation of efficacy and adherence to INH preventive therapy in children at risk to develop active tuberculosis

ObjectivesRevised National Tuberculosis Control Program and Indian Academy of Pediatrics advocate 6 months of INH Preventive Therapy (IPT) for children less than 6 years who are in contact with an infectious pulmonary tuberculosis case, irrespective of their BCG or nutritional status. Isoniazid is also recommended by Indian Pediatric Nephrology group for children with nephrotic syndrome who are asymptomatic mantoux positive (latent tuberculosis) and who require steroid therapy. Poor adherence to INH is a major barrier in implementing IPT. Objective of this study was to evaluate the efficacy of IPT in preventing active disease in the above groups and to assess the adherence to IPT in these children.MethodsProspective study conducted at department of paediatrics at a tertiary care teaching hospital, from April 2006 to October 2011. Study involved initiation of IPT in groups mentioned above (group 1 – children less than 6 years in contact with infectious adults and group 2 – asymptomatic mantoux positive children with nephrotic syndrome requiring steroid therapy) and follow-up of cohort at regular intervals for development of active disease and adherence to prescribed therapy.ResultsA total of 50 children were included in the study (group 1 – 31 children and group 2 – 19 children). Forty-three (86%) children completed 6 months of prescribed INH treatment. Mean duration of follow-up was 12.29 (±13.13) months post-treatment. None of children who adhered to treatment developed active disease.ConclusionsOur study suggests that IPT is effective in preventing active disease in both children in contact with infectious adults and those with nephrotic syndrome and latent infection. Adherence can be enhanced by counseling of parents at the start of therapy and reemphasis during subsequent follow-ups.