Common antibiotic can prevent drug-resistant TB in exposed kids, says study. But is it safe?

Two clinical trials —TB-CHAMP and VQUIN – provide supportive evidence about safe and effective treatment to prevent multidrug-resistant TB in both children and adults. The findings were presented at the World Union Conference on Lung Health in Paris.

“There have been many advancements in science around preventing drug-susceptible TB but very little rigorous data on preventing drug-resistant TB,” says Professor Anneke Hesseling, Director of the Desmond Tutu TB Centre and the overall Principal Investigator of the TB-CHAMP trial, at Stellenbosch University. Since the trial demonstrates levofloxacin as a safe option for preventing disease in five-year-olds exposed to MDR-TB by 56 per cent, he hopes this would be part of public health protocols.

According to the report, 453 children, who had been exposed to an adult with MDR-TB in their household, were given levofloxacin once daily for six months. Only five developed MDR-TB. There were very few side events from the medicine. Specifically joint pain and tendonitis, traditionally a concern, were very uncommon in children receiving levofloxacin.

The second trial – the V-QUIN Phase 3 clinical trial conducted by researchers from the Woolcock Institute of Medical Research at the University of Sydney and the Vietnam National Tuberculosis Program – has found that levofloxacin reduced the risk of MDR-TB in adults and adolescents by 45 per cent.

How do the finding work for India?

These guideline-changing trials inform national policies on how close contacts of MDR-TB patients can receive preventive therapy with levifloxacin, a widely available drug in India. As Dr Vidya Mave, Director, Johns Hopkins India Program, says, “India has already rolled out levofloxacin prophylaxis for MDR-TB household contacts and these trial results provide much needed evidence in this space.”

Is there a matter of concern?

However, noted pulmonologist Dr Zarir F Udwadia and other experts feel that the findings need to be debated before they can be recommended for public policy. In their editorial published in Lung India in August, they had written that all transmissions do not take place in home settings and children can get exposed to the infection in schools and adults in workplaces.

“However we would argue that all household contacts of MDR-TB patients should be very carefully followed up and promptly treated as soon as they are known to be infected. This is a better strategy than all healthy contacts receiving treatment of unknown efficacy with toxic drugs, which may predispose them to possible future resistance. The current WHO guidelines would also seem to endorse this more prudent approach,” Dr Udwadia and others wrote in their letter.

According to the World TB Report, approximately 28.2 lakh people got TB in India in 2022 and the country’s contribution to the global burden is 27 per cent.