Update on multidrug-resistant tuberculosis preventive therapy toward the global tuberculosis elimination
Abstract
Multidrug-resistant tuberculosis (MDR-TB), the deadliest form of tuberculosis (TB), has been included in the 2024 World Health Organization (WHO) priority list of antibiotic-resistant bacterial pathogens owing to its severe public health implications. Almost two billion people worldwide are infected with Mycobacterium tuberculosis; however, the share of MDR-M.tuberculosis remains uncertain. Mathematical modeling estimates that MDR-TB affects nearly three in every 1000 people worldwide, highlighting the urgent need to address TB preventive treatment (TPT) for contacts of MDR-TB cases. Before 2018, close monitoring of contacts of people with MDR-TB was recommended rather than TPT. However, considering the ethical and public health concerns associated with leaving infected individuals untreated, the WHO updated its guidelines in 2018, 2020, and 2022. Despite the limited evidence at the time, the WHO suggested considering quinolone-based TPT for selected high-risk cases. To close this gap in evidence, two large-scale prospective randomized controlled trials were conducted: VQUIN (VQUIN MDR Australia New Zealand Clinical Trials Registry number, ACTRN12616000215426) and TB-CHAMP (TB-CHAMP ISRCTN Registry number, ISRCTN92634082). Both trials evaluated the efficacy of levofloxacin (Lfx) compared with a placebo for MDR-TB after household exposure in adults and children. A combined meta-analysis of the two trials showed a 60% reduction in TB incidence in the Lfx group, and the…
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