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Kaimen Rigor review

Levofloxacin Preventive Treatment in Children Exposed to MDR Tuberculosis.

Hesseling AC, Purchase SE, Martinson NA, Fairlie L, Schaaf HS, Brigden J, Staples S, Gibb DM, Garcia-Prats A, Conradie F, McGowan C, Layton C, Batist E, Demers AM, Nyamathe S, Frigati L, Turner R, Duong T, Seddon JA

DOI: 10.1056/NEJMoa2314318
Record issued: 2026-08-16
Engine: 7.39.0
Exported: 2026-09-21

Prepared by Alpha1. This document is confidential: it is intended for the recipient it was shared with and must not be redistributed. The live record at alpha1science.com/verify/59007107-11ff-49a8-83ef-6b809db5f38f is authoritative.

Kaimen Rigor review

Kaimen Rigor reviewed

3.75 / 5

Adequate — real issues to address

Interventional Study

Critical

High-priority

How this rating was calculated

Started at 5★ — deductions

IntegrityIntegrity concern−0.5★
ClaimsTreatment effect not shown to be clinically meaningful−0.5★
ReportingData & code availability partially met−0.25★

Model-reported confidence: highReviewer agreement: highEngine: 7.39.0Source: full text

Not verified in this report

No data or code availability links were detected to verify.

Biggest issues

01Treatment effect not shown to be clinically meaningful
highOverreachreviewer-assessedFull detail
The primary outcome shows a hazard ratio of 0.44 (95% CI 0.15-1.25) with a p-value of 0.12, which is not statistically significant. The absolute risk reduction is 1.5% (from 2.6% to 1.1%), but the confidence interval is wide and includes the null. The effect is not statistically supported, and the manuscript does not anchor the effect size to a clinically meaningful threshold. The trial was underpowered due to lower than expected event rates.
“Five (1.1%) in the levofloxacin-arm and 12 (2.6%) in the placebo-arm developed TB by 48-weeks (hazard ratio [HR] 0.44; 95% confidence interval 0.15-1.25).”
Find in source

Findings by category

101ArithmeticNumerical inconsistencies 202OverreachOverstated conclusions 03AuthenticityNone found 104DisclosureReporting gaps 05AvailabilityNone found · partly checked 06Copyedit20 minor suggestions

This Kaimen Rigor review uses Kaimen Rigor reviewers trained on a curated corpus of high-fidelity and retracted papers, with expert supervision and curation. It can still make mistakes; verify each finding against the source before relying on it.

This is a well-conducted cluster-randomized trial with rigorous design, clear reporting of biological variables, and appropriate statistical methods. The main weakness is the lack of a clear data availability statement and code sharing, which limits reproducibility.

Both reviewers agreed on the study type and all dimension statuses. The statistics verification component recomputed 9 tests, all consistent, but coverage is limited to tests with test statistics or effect estimates with CIs. The citation check found no retracted or unresolved references.

Numerical inconsistencies

1 finding · worst low

Values that contradict each other or are impossible for the stated sample: recomputed p-values and test statistics, GRIM/GRIMMER checks on summary numbers, percentages against their own counts, totals against their parts, and estimates against their own confidence intervals.

Internal contradictions in the reported numbersAssessed

Recomputed 9 tests: 9 consistent, 0 inconsistent; 2 recomputed directly from the reported test statistics, 7 via agent-written checks.

Agent-written checks— recomputed from reported CIs / ratios by code the agent wrote

CONSISTENTreported p = .290 · recomputed p = .279
Recomputed HR 0.52 (95% CI 0.16–1.71), reported p=0.29
“HR 0.52; 95%CI 0.16 - 1.71; P=0.29”
Find in source
Taken as given: 0.16–1.71 is a two-sided 95% confidence interval for the HR of 0.52, not a range, an IQR, or a different interval level; the HR is a RATIO measure, so the interval is symmetric on the log scale; p=0.29 is the p for THIS estimate, not for another comparison in the same sentence
Method: back the two-tailed p out of the log-scale CI width and compare it against the printed p
How we recomputed it: pCI(0.52, 0.16, 1.71, 1)
CONSISTENTreported p = .210 · recomputed p = .207
Recomputed HR 0.64 (95% CI 0.32–1.28), reported p=0.21
“HR 0.64; 95% CI 0.32 - 1.28; P=0.21”
Find in source
Taken as given: 0.32–1.28 is a two-sided 95% confidence interval for the HR of 0.64, not a range, an IQR, or a different interval level; the HR is a RATIO measure, so the interval is symmetric on the log scale; p=0.21 is the p for THIS estimate, not for another comparison in the same sentence
Method: back the two-tailed p out of the log-scale CI width and compare it against the printed p
How we recomputed it: pCI(0.64, 0.32, 1.28, 1)
CONSISTENTreported p = .120 · recomputed p = .129Reviewers 1, 2
Primary efficacy HR p-value from CI
“hazard ratio [HR] 0.44; 95% CI 0.15-1.25; P=0.12”
Find in source
Taken as given: The HR is 0.44 with 95% CI 0.15-1.25.; The CI is two-sided at 95%.; The p-value is two-tailed.
Method: Recomputed two-tailed p from HR and 95% CI using the pCI function for a ratio.
How we recomputed it: pCI(0.44, 0.15, 1.25, 1)
CONSISTENTreported p = .140 · recomputed p = .135Reviewers 1, 2
Discontinuation due to AE HR p-value from CI
“HR 5.00 ; 95%CI 0.61-41.32 ) ; P =0.14”
Find in source
Taken as given: The HR is 5.00 with 95% CI 0.61-41.32.; The CI is two-sided at 95%.; The p-value is two-tailed.
Method: Recomputed two-tailed p from HR and 95% CI using the pCI function for a ratio.
How we recomputed it: pCI(5.00, 0.61, 41.32, 1)
CONSISTENTreported p = .690 · recomputed p = .697Reviewers 1, 2
SAE HR p-value from CI
“1.22 (0.45-3.34) 0.69”
Find in source
Taken as given: The HR is 1.22 with 95% CI 0.45-3.34.; The CI is two-sided at 95%.; The p-value is two-tailed.
Method: Recomputed two-tailed p from HR and 95% CI using the pCI function for a ratio.
How we recomputed it: pCI(1.22, 0.45, 3.34, 1)
CONSISTENTreported p = .690 · recomputed p = .682Reviewers 1, 2
Arthritis/arthralgia/tendinopathy HR p-value from CI
“1.32 (0.35-4.98) 0.69”
Find in source
Taken as given: The HR is 1.32 with 95% CI 0.35-4.98.; The CI is two-sided at 95%.; The p-value is two-tailed.
Method: Recomputed two-tailed p from HR and 95% CI using the pCI function for a ratio.
How we recomputed it: pCI(1.32, 0.35, 4.98, 1)
CONSISTENTreported p = .300 · recomputed p = .311Reviewers 1, 2
CNS effects HR p-value from CI
“0.59 (0.21-1.62) 0.30”
Find in source
Taken as given: The HR is 0.59 with 95% CI 0.21-1.62.; The CI is two-sided at 95%.; The p-value is two-tailed.
Method: Recomputed two-tailed p from HR and 95% CI using the pCI function for a ratio.
How we recomputed it: pCI(0.59, 0.21, 1.62, 1)
CONSISTENTreported p = .290 · recomputed p = .279Reviewer 2
Secondary safety endpoint HR p-value
“HR 0.52; 95%CI 0.16-1.71; P=0.29”
Find in source
Taken as given: The HR is 0.52 with 95% CI 0.16-1.71.; The CI is two-sided at 95%.; The p-value is two-tailed.
Method: Recomputed p from HR and CI using the normal approximation for the log hazard ratio.
How we recomputed it: pCI(0.52, 0.16, 1.71, 1)
CONSISTENTreported p = .210 · recomputed p = .207Reviewer 2
Secondary safety endpoint HR p-value
“HR 0.64; 95% CI 0.32-1.28; P=0.21”
Find in source
Taken as given: The HR is 0.64 with 95% CI 0.32-1.28.; The CI is two-sided at 95%.; The p-value is two-tailed.
Method: Recomputed p from HR and CI using the normal approximation for the log hazard ratio.
How we recomputed it: pCI(0.64, 0.32, 1.28, 1)

lowinternal contradiction
The abstract states 'Of 922 participants from 497 households, 453 were randomly assigned to receive levofloxacin and 469 placebo' but the results section reports 'Five (1.1%) of 451 children in the levofloxacin-arm and 12 (2.6%) of 465 children in the placebo-arm developed TB by 48-weeks'. The denominators differ (451 vs 453, 465 vs 469) due to late screening failures, which is explained in the text.
Of 922 participants from 497 households, 453 were randomly assigned to receive levofloxacin and 469 placebo; ... Five (1.1%) of 451 children in the levofloxacin-arm and 12 (2.6%) of 465 children in the placebo-arm developed TB by 48-weeks
Abstractreviewer’s wording

Overstated conclusions

2 findings · worst high

Conclusions that reach past what the paper's own results support — including a significance claim that no longer holds when the statistic is recomputed, and efficacy resting on an unvalidated surrogate endpoint.

Treatment effect not shown to be clinically meaningfulAssessed
Conclusions only partially backed by the presented evidenceAssessed

8 major claims checked against the paper's own evidence: 3 only partially supported (evidence backs part of the claim; gaps or caveats remain); the rest adequately supported.

partialReviewers 1, 2
The lower-than-expected TB event rate may be due to more rapid initiation of effective MDR-TB treatment and rigorous baseline screening.
The paper offers plausible explanations but does not provide direct evidence to confirm these mechanisms. The claim is speculative but reasonable.
Evidence: Discussion: 'Given the wide rollout of Xpert MTB/RIF in South Africa, it is possible that individuals with MDR-TB are now initiated more rapidly onto appropriate MDR-TB therapy...'
Given the wide rollout of Xpert MTB/RIF in South Africa, it is possible that individuals with MDR-TB are now initiated more rapidly onto appropriate MDR-TB therapy, reducing the duration of exposure for household contacts, reducing the risk of Mtb transmission.
Discussionreviewer’s wording
partialReviewer 1
Levofloxacin may have treated sub-clinical disease, preventing disease progression, but had minimal post-antibiotic effect.
The timing of TB events (most in placebo arm early, most in levofloxacin arm later) supports this hypothesis, but it is an inference from the data, not a direct measurement.
Evidence: Results: 'One child in the levofloxacin-arm developed TB during the 24-week treatment period, compared to 10 in the placebo-arm'
Levofloxacin may therefore have treated sub-clinical disease, prevented disease progression, but had minimal post-antibiotic effect.
Discussionreviewer’s wording
partialReviewer 2
Levofloxacin may treat subclinical disease and prevent progression, but has minimal post-antibiotic effect.
The timing of TB events supports this hypothesis, but it is speculative and not directly tested.
Evidence: Observation that most placebo events occurred early, while levofloxacin events occurred later.
“In the placebo arm, most events occurred in the first 12 weeks, suggesting that many children, while not having clinically overt disease at baseline, had some form of subclinical disease that rapidly progressed to symptomatic disease.”
Discussion ¶4Find in source
supportedReviewer 1
Levofloxacin preventive treatment reduces the risk of TB disease in children exposed to MDR-TB, though not statistically significant.
The paper reports a hazard ratio of 0.44 with 95% CI 0.15-1.25, indicating a reduction but not statistically significant. The claim is accurately stated as not statistically significant.
Evidence: Primary outcome: 5/451 vs 12/465, HR 0.44 (95% CI 0.15-1.25), P=0.12
“Although fewer developed TB disease in the levofloxacin group this was not statistically significant.”
DiscussionFind in source
supportedReviewer 1
Levofloxacin did not demonstrate any safety concerns in children.
The safety analysis showed no significant differences in grade ≥3 AEs, SAEs, or discontinuations due to AEs. The claim is supported by the reported safety outcomes.
Evidence: Grade ≥3 AEs: 4/452 vs 8/469, HR 0.52 (95% CI 0.16-1.71); SAEs: 9/452 vs 8/469, HR 1.22 (95% CI 0.45-3.34)
We demonstrate that daily levofloxacin, taken for six months, did not demonstrate any safety concerns in children.
Discussionreviewer’s wording
supportedReviewer 1
Adherence to study drug was high (86-87%) in both arms.
The paper reports 87% in levofloxacin arm and 86% in placebo arm received ≥80% of allocated doses, supporting the claim.
Evidence: Results: 87% of children in the levofloxacin-arm and 86% in the placebo-arm received ≥80% of allocated doses
87% of children in the levofloxacin-arm and 86% in the placebo-arm received ≥80% of allocated doses
Resultsreviewer’s wording
supportedReviewer 2
Levofloxacin preventive treatment reduces TB incidence in children exposed to MDR-TB, though not statistically significant.
The claim is supported by the primary analysis showing fewer TB cases in the levofloxacin arm (HR 0.44, 95% CI 0.15-1.25), though the confidence interval includes 1 and the p-value is 0.12.
Evidence: Primary outcome: 5/451 vs 12/465, HR 0.44 (0.15-1.25), P=0.12.
Five (1.1%) in the levofloxacin-arm and 12 (2.6%) in the placebo-arm developed TB by 48-weeks (hazard ratio [HR] 0.44; 95% confidence interval 0.15-1.25).
Abstractreviewer’s wording
supportedReviewer 2
Levofloxacin is safe in children, with no concerning safety signals.
The safety analysis shows no significant difference in grade ≥3 AEs between arms, and the single tendonitis case was grade 2 and resolved.
Evidence: Safety outcomes: grade ≥3 AEs possibly related: 4/452 vs 8/469, HR 0.52 (0.16-1.71).
Four levofloxacin-arm vs. 8 placebo-arm participants developed grade ≥ 3 adverse events at least possibly related to study drug (HR 0.52; 95% CI 0.16-1.71).
Abstractreviewer’s wording

Premise concern: effect size not shown to be clinically meaningful.

ADEQUATESurrogate endpoint
The primary efficacy endpoint is incident TB disease or TB death by 48 weeks, which is a hard clinical outcome, not a surrogate. The trial directly measures the clinical endpoint of TB disease, so the surrogate criterion is not applicable.
“The primary endpoint was incident TB disease (microbiologically-confirmed or clinically-diagnosed) or TB death by 48-weeks following randomization”
Find in source
INADEQUATEEffect size
The primary outcome shows a hazard ratio of 0.44 (95% CI 0.15-1.25) with a p-value of 0.12, which is not statistically significant. The absolute risk reduction is 1.5% (from 2.6% to 1.1%), but the confidence interval is wide and includes the null. The effect is not statistically supported, and the manuscript does not anchor the effect size to a clinically meaningful threshold. The trial was underpowered due to lower than expected event rates.
“Five (1.1%) in the levofloxacin-arm and 12 (2.6%) in the placebo-arm developed TB by 48-weeks (hazard ratio [HR] 0.44; 95% confidence interval 0.15-1.25).”
Find in source

Data authenticity concerns

None found

An adversarial read for patterns associated with data that may not be genuine: results that look too clean, implausibly large effects, duplicated data or images, and methods that do not match the results reported.

Checked — nothing surfaced.

Reporting gaps

1 finding · worst medium

Required detail the manuscript never states — study design, biological variables, ethics approval and consent, key resources, statistical reporting, data and code availability, and overall transparency.

Data/code availability incompleteAssessed

Eight Dimensions7 pass · 1 warn

The introduction cites prior observational data and WHO conditional recommendations, and clearly states the lack of randomized controlled trial evidence for MDR-TB preventive treatment. The rationale for the trial is logically derived from the high risk of disease progression in young children and the need for trial data. Limitations of prior research are implicitly addressed by the trial design, though not explicitly detailed.

Sub-criteria

prior work citedADEQUATE

premise rationaleADEQUATE

limitations addressedINADEQUATE

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 90% conf

The paper establishes a clear scientific premise, citing prior research and identifying the evidence gap for MDR-TB preventive treatment in children.

Evidence

paraphrase[Introduction, paragraph 1]

“There is good evidence for the efficacy and safety of TB preventive treatment for individuals exposed to drug-susceptible TB, but data from randomized-controlled trials for MDR-TB are lacking.”

paraphrase[Introduction, paragraph 2]

“Young children, particularly those <5 years, are an important population for TB preventive treatment given their higher risk of faster disease progression following TB exposure and risk of severe forms of TB.”

absence[Introduction]

Limitations of prior research are not explicitly discussed in the introduction.

PASSReviewer 2· 90% conf

The paper establishes a clear scientific premise with adequate citation of prior work and a logical rationale for the trial.

Evidence

paraphrase[Introduction, paragraph 1]

“There is good evidence for the efficacy and safety of TB preventive treatment for individuals exposed to drug-susceptible TB, but data from randomized-controlled trials for MDR-TB are lacking.”

paraphrase[Introduction, paragraph 2]

“We undertook a clinical trial to compare levofloxacin versus placebo in children/adolescents exposed to a person with infectious MDR-TB in their household.”

Randomization was at household level, stratified by site, using computer-generated block randomization. The trial was double-blind with placebo control. A power calculation was provided (80% power to detect 60% reduction, assuming 7% incidence). Inclusion/exclusion criteria were described, and the modified intention-to-treat population was defined. Outlier handling is addressed through the pre-specified analysis population and censoring rules. Controls are inherent in the placebo arm. Independent replication is not applicable for a single pivotal trial.

Sub-criteria

controlsADEQUATE

power analysisADEQUATE

blinding levelsADEQUATE

outlier handlingADEQUATE

randomization unitADEQUATE

inclusion exclusionADEQUATE

randomization methodADEQUATE

replicate distinctionN/A

independent replicationN/A

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 95% conf

The trial design is rigorous with appropriate randomization, blinding, power calculation, and pre-specified analysis populations.

Evidence

paraphrase[Methods, Trial design]

“Randomization was at household-level, stratified by site, with 1:1 allocation to either levofloxacin or placebo. Randomization was by a computer-generated randomization list prepared by the trial statistician using block randomization with varying block size, incorporated in a centralized web-based database.”

paraphrase[Methods, Trial design]

“TB-CHAMP was a multi-site, cluster-randomized, double-blind placebo-controlled trial”

paraphrase[Methods, Statistical Analysis]

“We calculated that 1009 participants would provide 80% power to detect a 60% reduction in incident TB by 48-weeks, at a two-sided significance level of 5%.”

PASSReviewer 2· 95% conf

The trial design is rigorous with adequate randomization, blinding, power analysis, and pre-specified analysis populations.

Evidence

paraphrase[Methods, Trial design]

paraphrase[Methods, Statistical Analysis]

“We calculated that 1009 participants would provide 80% power to detect a 60% reduction in incident TB by 48-weeks, at a two-sided significance level of 5%.”

paraphrase[Abstract]

“TB-CHAMP was a community-based multi-site household cluster-randomized double-blind placebo-controlled trial”

Sex, age, HIV status, IGRA status, and BCG vaccination are reported in Table 1. Since both sexes were enrolled, sex justification is not applicable. Age and health status are reported. Demographics include ethnicity and site. Species/strain and housing conditions are not applicable for a human trial.

Sub-criteria

demographicsADEQUATE

sex reportedADEQUATE

sex justifiedN/A

age weight healthADEQUATE

housing conditionsN/A

species strain sourceN/A

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 90% conf

Key biological variables including sex, age, HIV status, and IGRA status are reported in baseline characteristics.

Evidence

“Sex Male 213 (47%) 241 (51%) 454 (49%) Female 240 (53%) 228 (49%) 468 (51%)”

Table 1Find in source

paraphrase[Table 1]

“HIV status Positive 10 (2%) 9 (2%) 19 (2%) HIV-exposed uninfected 153 (34%) 160 (34%) 313 (34%) HIV-unexposed 288 (64%) 298 (64%) 586 (64%)”

“Ethnicity Black 362 (80%) 381 (81%) 743 (81%) South African mixed 81 (18%) 78 (17%) 159 (17%)”

Table 1Find in source

PASSReviewer 2· 90% conf

Biological variables are well reported for a pediatric trial, including sex, age, HIV status, and IGRA status.

Evidence

“Sex Male 213 (47%) 241 (51%) 454 (49%) Female 240 (53%) 228 (49%) 468 (51%)”

Table 1Find in source

“Ethnicity Black 362 (80%) 381 (81%) 743 (81%)”

Table 1Find in source

The paper states that the study was approved by all institutional and national ethics committees, and informed consent was obtained from parents/caregivers, with assent from older children. However, the specific ethics committee names are not provided in the main text (likely in the supplement). Regulatory compliance is implied by adherence to standard trial practices.

Sub-criteria

iacuc statementN/A

informed consentADEQUATE

irb ethics statementINADEQUATE

regulatory complianceINADEQUATE

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 85% conf

Ethical approval and informed consent are reported, though the specific ethics committee is not named in the main text.

Evidence

“The study was approved by all institutional and national ethics committees (Supplement).”

MethodsFind in source

paraphrase[Methods, Trial design]

“Children <5 years were recruited following written informed consent from their parent/caregiver if exposure to the MDR-TB index patient had been substantial in the preceding 6 months.”

absence[Methods]

Regulatory compliance is not explicitly stated.

PASSReviewer 2· 85% conf

Ethical approvals and consent are adequately reported.

Evidence

“The study was approved by all institutional and national ethics committees (Supplement).”

MethodsFind in source

paraphrase[Methods, Trial design]

“Children <5 years were recruited following written informed consent from their parent/caregiver if exposure to the MDR-TB index patient had been substantial in the preceding 6 months.”

Levofloxacin and placebo are identified with manufacturer (Macleods Pharmaceuticals) and formulation. The IGRA assay (QuantiFERON-Gold Plus, Qiagen) is identified. Statistical software (Stata version 16.0) is named. Other bench resources are not applicable.

Sub-criteria

mycoplasma testingN/A

reagents identifiedADEQUATE

organisms identifiedN/A

antibodies identifiedN/A

cell line authenticationN/A

software tools identifiedADEQUATE

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 90% conf

The investigational product (levofloxacin) is identified with manufacturer and dosing, and statistical software is named.

Evidence

paraphrase[Methods, Treatment]

“Study medications were manufactured by Macleods Pharmaceuticals, India, as 250mg scored tablets levofloxacin or levofloxacin-placebo”

paraphrase[Methods, Trial design]

“interferon-gamma release assay (IGRA, QuantiFERON-Gold Plus, Qiagen)”

“Analyses used Stata version 16.0 or later (StataCorp).”

Statistical analysisFind in source

PASSReviewer 2· 90% conf

The investigational product (levofloxacin) is adequately identified, and statistical software is named.

Evidence

paraphrase[Methods, Treatment]

“Study medications were manufactured by Macleods Pharmaceuticals, India, as 250mg scored tablets levofloxacin or levofloxacin-placebo”

“Analyses used Stata version 16.0 or later (StataCorp).”

Statistical analysisFind in source

The primary analysis used Cox regression with cluster-robust variance, and the paper reports exact p-values (e.g., P=0.12) and hazard ratios with 95% CIs. Assumptions were checked via the Grambsch-Therneau test. Statistical software is identified. Data presentation includes Kaplan-Meier curves and tables with per-group n. Mathematical plausibility checks are not applicable for large-N continuous outcomes.

Sub-criteria

tests namedADEQUATE

exact p valuesADEQUATE

effect sizes ciADEQUATE

data presentationADEQUATE

software identifiedADEQUATE

assumptions verifiedADEQUATE

mathematical plausibilityN/A

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 90% conf

Statistical methods are appropriate and well-described, with exact p-values and effect sizes with confidence intervals.

Evidence

paraphrase[Methods, Statistical Analysis]

“We used Cox regression to estimate the hazard ratio (HR) comparing levofloxacin versus placebo, with cluster-robust variance accounting for intra-household correlation.”

paraphrase[Results, Primary Outcome]

“hazard ratio [HR] 0.44; 95% CI 0.15-1.25; P=0.12”

paraphrase[Methods, Statistical Analysis]

“We assessed for evidence of non-proportional hazards using the Grambsch-Therneau test based on scaled Schoenfeld residuals.”

PASSReviewer 2· 90% conf

Statistical methods are appropriate and well-reported, with exact p-values and effect sizes with confidence intervals.

Evidence

paraphrase[Results, Primary Outcome]

“hazard ratio [HR] 0.44; 95% CI 0.15-1.25; P=0.12”

paraphrase[Results, Primary Outcome]

“hazard ratio [HR] 0.44; 95% CI 0.15-1.25”

The paper does not include a specific data availability statement in the provided text. The trial is registered (ISRCTN92634082), but no data sharing mechanism is described. Since this is a clinical trial with patient data, managed access would be acceptable, but the absence of any statement is a gap.

Sub-criteria

code sharingN/A

accession numbersN/A

repository depositN/A

data availability statementNOT REPORTED

Per reviewer (2) — the votes behind the verdict

WARNReviewer 1· 80% conf

A data availability statement is present but vague, and no data or code repository is mentioned.

Evidence

absence[Entire paper]

No data availability statement is present.

WARNReviewer 2· 80% conf

A data availability statement is present but vague, and no data repository or code is provided.

Evidence

“Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.”

DiscussionFind in source

The trial registration number is provided (ISRCTN92634082). Methods are detailed enough for replication. Limitations are explicitly discussed, including lower-than-expected event rate and generalizability. Conclusions are appropriately cautious, noting the lack of statistical significance. Funding and COI are disclosed.

Sub-criteria

funding coiADEQUATE

trial registrationADEQUATE

reporting guidelineNOT REPORTED

methods completenessADEQUATE

all outcomes reportedADEQUATE

limitations discussedADEQUATE

conclusions proportionalADEQUATE

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 90% conf

The trial is registered, methods are detailed, limitations are discussed, and conclusions are proportional.

Evidence

“ISRCTN92634082”

AbstractFind in source

paraphrase[Discussion]

“Our trial has limitations. The event rate in the placebo-arm was lower than anticipated. There are also limitations to generalizability.”

paraphrase[Acknowledgements]

“Funders UNITAID, through the BENEFIT Kids project grant (2019-36-SUN-MDR) to Stellenbosch University.”

PASSReviewer 2· 90% conf

The trial is registered, methods are complete, limitations are discussed, and conclusions are proportional.

Evidence

paraphrase[Abstract]

“(ISRCTN92634082.)”

paraphrase[Discussion, paragraph 5]

“Our trial has limitations. The event rate in the placebo-arm was lower than anticipated.”

Registered (2 IDs: ClinicalTrials.gov, ISRCTN). No reporting guideline cited.

ClinicalTrials.gov

NCT03568383

ISRCTN

ISRCTN92634082

Broken references and links

None found · partly checked

References checked against Crossref, OpenAlex and Retraction Watch for retractions and resolvability, plus declared data and code links probed for whether they resolve to content matching the paper.

Nothing surfaced — but not everything feeding this category ran (missing: data/code link verification), so read this as a partial clean bill.

Checked 22 references by DOI: 17 verified — 5 no DOI (shown, not verified).

NO DOI
Global tuberculosis report
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
The End TB Strategy
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
WHO consolidated guidelines on tuberculosis: tuberculosis preventive treatment
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
The natural history of childhood intra-thoracic tuberculosis: a critical review of literature from the pre-chemotherapy era
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Protecting Households On Exposure to Newly Diagnosed Index Multidrug-Resistant Tuberculosis Patients (PHOENIx MDR-TB)
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).

Copyediting

20 minor

Wording, consistency and formatting errors that need correcting before submission.

No major wording or formatting errors. 20 minor suggestions below.

20 copyedit issues flagged: mostly typo, consistency, clarity.

MINORtypoAbstract
“S ensitivity analyses”
→ Sensitivity analyses
Extra space and capitalization.
MINORtypoAbstract
“O ne child”
→ One child
Extra space.
MINORtypoResults, Primary Outcome
“P=0.12 )”
→ P=0.12)
Extra space before parenthesis.
MINORtypoResults, Secondary Outcomes
“P =0.14)”
→ P=0.14)
Extra space.
MINORtypoDiscussion
“w e recruited”
→ we recruited
Capitalization.
MINORtypoDiscussion
“rigorous ly”
→ rigorously
Extra space.
MINORtypoDiscussion
“demonstra ted”
→ demonstrated
Extra space.
MINORtypoDiscussion
“inciden t TB”
→ incident TB
Extra space.
MINORtypoDiscussion
“followe d regular ly”
→ followed regularly
Extra spaces.
MINORtypoDiscussion
“S afety”
→ Safety
Capitalization.
MINORtypoDiscussion
“ grade 3”
→ grade ≥3
Symbol formatting.
MINORtypoDiscussion
“recruit ed”
→ recruited
Extra space.
MINORtypoDiscussion
“expanding late r”
→ expanding later
Extra space.
MINORtypoDiscussion
“C are”
→ Care
Capitalization.
MINORtypoDiscussion
“n ationally”
→ nationally
Capitalization.
MINORtypoAbstract, Results
“S ensitivity analyses were consistent with results from the primary analyses.”
→ Remove extra space after 'S'.
Minor typo.
MINORtypoAbstract, Results
“O ne child in the levofloxacin arm developed tendonitis (grade 2).”
→ Remove extra space after 'O'.
Minor typo.
MINORtypoMethods, Statistical Analysis
“We used Cox regression to estimate the hazard ratio (HR) comparing levofloxacin versus placebo, with cluster-robust variance account ing for intra-household correlation.”
→ Change 'account ing' to 'accounting'.
Minor typo.
MINORconsistencyResults, Primary Outcome
“Five (1.1%) of 451 children in the levofloxacin-arm and 12 (2.6%) of 465 children in the placebo-arm developed TB by 48-weeks”
→ Ensure consistency with the mITT population of 916 (451+465=916).
Numbers are consistent with mITT.
MINORclarityDiscussion, paragraph 4
“A systematic review of MDR-TB preventive treatment 7 demonstrated a risk reduction of 90%.”
→ Clarify that this is from observational data, not RCTs.
Clarity improvement.

Kaimen Rigor Action ItemsFinal pass before journal submission

The published work is robust and well-reported, but readers should weigh the lack of a clear data availability statement and code sharing when assessing reproducibility. The minor copyedit issues and the vague data statement warrant attention, though they do not undermine the core findings.

1.
HIGHdata code
Add a clear data availability statement in the Methods or a dedicated section, specifying how de-identified data can be accessed (e.g., via a data access committee or repository) with conditions and timeframe.
The current statement is vague and does not provide a clear mechanism for data access, which is a key reproducibility gap.
2.
HIGHdata code
Deposit the statistical analysis code (e.g., Stata do-files) in a public repository and provide a link in the manuscript.
Sharing code enhances transparency and allows independent verification of the analyses.
3.
MEDIUMethics
Name the specific ethics committees that approved the study in the main text, not just in the supplement.
Naming the committees strengthens the ethics reporting and is expected by readers and journals.
4.
MEDIUMreporting
Explicitly state compliance with the Declaration of Helsinki or other regulatory framework in the Methods.
Explicit regulatory compliance statements are standard for clinical trials and reassure readers.
5.
MEDIUMreporting
Mention adherence to CONSORT reporting guidelines in the manuscript.
Explicitly stating CONSORT adherence helps readers assess the completeness of reporting.
6.
MEDIUMreporting
Clarify the handling of missing data for secondary outcomes, as the current statement only addresses the primary model.
Transparent missing data handling is important for interpreting secondary analyses.
7.
MEDIUMreporting
Include a statement on the availability of the full protocol and statistical analysis plan.
Providing access to the protocol and SAP enhances transparency and reproducibility.
8.
LOWcopyedit
Fix the typo in the Abstract: 'S ensitivity analyses' should be 'Sensitivity analyses'.
Minor typos detract from the professionalism of the manuscript.
9.
LOWcopyedit
Fix the typo in the Abstract: 'O ne child' should be 'One child'.
Minor typos detract from the professionalism of the manuscript.
10.
LOWcopyedit
Fix the extra space in 'P=0.12 )' in Results, Primary Outcome.
Minor formatting issues should be corrected for consistency.
11.
LOWcopyedit
Fix the extra space in 'P =0.14)' in Results, Secondary Outcomes.
Minor formatting issues should be corrected for consistency.
12.
LOWcopyedit
Fix the capitalization in 'w e recruited' in Discussion.
Minor typos detract from the professionalism of the manuscript.
13.
LOWcopyedit
Fix the extra spaces in 'rigorous ly', 'demonstra ted', 'inciden t TB', 'followe d regular ly', 'recruit ed', 'expanding late r' in Discussion.
Minor typos detract from the professionalism of the manuscript.
14.
LOWcopyedit
Fix the capitalization in 'S afety', 'C are', 'n ationally' in Discussion.
Minor typos detract from the professionalism of the manuscript.
15.
LOWcopyedit
Fix the symbol formatting in 'grade 3' to 'grade ≥3' in Discussion.
Proper symbol formatting is expected in scientific manuscripts.
16.
LOWcopyedit
Fix the typo 'account ing' to 'accounting' in Methods, Statistical Analysis.
Minor typos detract from the professionalism of the manuscript.
17.
LOWother
Clarify in Discussion, paragraph 4, that the systematic review demonstrating a 90% risk reduction is from observational data, not RCTs.
Clarifying the evidence source prevents misinterpretation.

Full text (30,579 chars)Analyzed: Aug 16, 2026

RigorReviewer 1

RigorReviewer 2

RigorPre-Submission Reviewer

CopyeditAgent Scribe

CitationsCitation Integrity

StatisticsStatistics Consistency

PreregistrationDeterministic check· no model (rule-based)

The star rating is the report’s one-glance summary. Every paper starts at 5★ and loses stars for the concrete problems the review finds — so a rating is never a vague average, it’s a running total you can read line by line under “How this rating was calculated.”

How stars are deducted

Reporting — 8 dimensionseach dimension that fully fails−½★
each dimension partially met−¼★
Statistics · Integrity · Claimseach serious problem−1★
each medium problem−½★
Citationseach retracted or unverifiable reference−¼★
Copyeditonly when the manuscript needs a full edit−½★

The rating never drops below 1★, and a demonstrable critical failure (an impossible statistic, a proven ethics violation) caps it at 1★ on its own — so the stars can never look healthy when the verdict is CRITICAL.

The rating draws on a panel of agents. Three independent Kaimen Rigor reviewers grade the eight dimensions below across several independent passes (the shown verdict is their majority vote — steadier than any single run), isolate the paper’s major claims and check its own evidence backs them, and flag integrity concerns. Alongside them, a citation agent resolves every reference against Crossref, OpenAlex, and Retraction Watch; a statistics agent recomputes reported tests; and rule-based checks verify that declared data/code links actually resolve. Full text is required — an abstract-only submission is not analyzed.

The eight reporting dimensions

Scientific PremisePrior work, rationale, and how it addresses gaps.

Study Design & RigorRandomization, blinding, power, controls, replication.

Biological VariablesSex, age, species/strain, housing, demographics.

Ethical ApprovalsIRB/IACUC approval, informed consent, regulatory compliance.

Key ResourcesAntibodies, cell lines, organisms, software — identified with persistent IDs.

Statistical ReportingNamed tests, exact p-values, effect sizes, plausible summary stats.

Data & Code AvailabilityAvailability statements, repositories, accession numbers, shared code.

Reporting TransparencyMethods, registration, guidelines, outcomes, limitations, funding/COI.

Graded against NIH, MDAR, ARRIVE 2.0, CONSORT, EQUATOR, and RRID guidelines. A dimension that doesn’t apply to the study type is skipped, never penalized.

This Kaimen Rigor review is model-assisted and is not a substitute for formal expert review. It complements human evaluation by surfacing potential methodological concerns — verify each finding against the source.

Levofloxacin Preventive Treatment in Children Exposed to MDR Tuberculosis.

DOI

10.1056/NEJMoa2314318

Record issued

2026-08-16

Engine

7.39.0

Exported

2026-09-21