The incidence of tuberculosis recurrence: Impacts of treatment duration of and adherence to standard anti-tuberculous therapy

Chung-Shu Lee; Chung-Han Ho; Kuang-Ming Liao; Yu-Cih Wu; Chin-Chung Shu

doi:10.1016/j.jiph.2023.09.005

The incidence of tuberculosis recurrence: Impacts of treatment duration of and adherence to standard anti-tuberculous therapy

J Infect Public Health. 2023 Nov;16(11):1778-1783. doi: 10.1016/j.jiph.2023.09.005. Epub 2023 Sep 11.

Authors

Chung-Shu Lee¹, Chung-Han Ho², Kuang-Ming Liao³, Yu-Cih Wu⁴, Chin-Chung Shu⁵

Affiliations

¹ Department of Pulmonary and Critical Care Medicine, New Taipei Municipal TuCheng Hospital, New Taipei City, Taiwan; Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University, School of Medicine, Taipei, Taiwan.
² Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan; Department of Information Management, Southern Taiwan University of Science and Technology, Tainan, Taiwan; Cancer Center, Taipei Municipal Wanfang Hospital, Taipei Medical University, Taipei, Taiwan.
³ Department of Internal Medicine, Chi Mei Medical Center, Chiali, Taiwan.
⁴ Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan.
⁵ Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan. Electronic address: ccshu@ntu.edu.tw.

PMID: 37738694
DOI: 10.1016/j.jiph.2023.09.005

Abstract

Background: We investigated the impacts of the standard treatment durations of and adherence to standard anti-tuberculous therapy (ATT) on recurrence after the successful completion of tuberculosis (TB) treatment.

Methods: We recruited patients with TB who had received treatment for six or nine months from the 2008-2017 databases of the Taiwanese National Health Insurance Research Database. Treatment duration and adherence to standard ATT were analyzed for their impacts on recurrence within two years. Complete adherence to standard ATT was defined as daily use of ethambutol, isoniazid, pyrazinamide, and rifampin for the first two months, and daily use of isoniazid and rifampin for the first six months.

Results: A total of 33,298 TB patients with new-onset TB were identified and classified into two groups by treatment duration: six months (n = 25,849, 77.63%) and nine months (n = 7449). Sex and age distributions varied between the groups. Treatment duration did not affect TB recurrence within two years (adjusted hazard ratio (AHR): 1.18, 95% confidence interval (C.I.) [0.96-1.44], p = 0.1156). Multivariable logistic regression showed that incomplete adherence to standard anti-tuberculous therapy (80-89% and 90-99% standard anti-TB therapy, AHR: 1.57, 95% C.I. [1.26-1.95], and 1.63, 95% C.I. [1.26-2.06], respectively, p < 0.0001) increased TB recurrence. In addition, male sex, older age, and comorbidity with diabetes mellitus or chronic obstructive pulmonary disease were independent risk factors for TB recurrence within two years.

Conclusions: TB recurrence was 1.54% within two years under a DOT era. TB treatment durations of six or nine months did not affect TB recurrence within two years after completion of TB treatment, but incomplete adherence to standard anti-tuberculous therapy might increase the TB recurrence rate.

Keywords: Complete adherence; TB recurrence; Treatment duration; Tuberculosis.