chemoprophylaxis for tuberculosis
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Management
- RULE OUT active tuberculosis prior to TB chemoprophylaxis
- indications for TB chemoprophylaxis
- a positive TST conversion within 2 years regardless of age
- persons with a history of untreated TB or radiographic evidence of previous TB
- all TST-positive individuals < 35 years of age.
- persons with a positive TST who are at high risk for TB
- new TST converters > 15 mm on serial testing
- household members & close contacts of patients with TB who have a positive TST (treat until PPD is negative 12 weeks later)
- INH prophylaxis 300 mg PO QD plus pyridoxine 50 mg QD for 6-9 months (12 months if HIV+)
- twice weekly schedule (directly observed therapy) is an alternative[9]
- rifapentine + INH weekly for 3 months for latent TB[4][11][13]
- otherwise healthy, >= 12 years of age
- high risk of developing TB
- includes patients with HIV not taking antiretroviral
- weekly dosing, total of 12 doses
- directly observed therapy
- rifampin + INH daily for 3 months for latent TB[4]
- rifampin 600 mg PO QD for 4-6 months[9]
- rifampin 600 mg PO QD + pyrazinamide 1.5-2.0 g PO QD for 2 months
- cases (including fatal cases) of hepatotoxicity[7]
- check liver function tests (LFTs) every 2 weeks[7]
- NO LONGER recommended[8]
- rifabutin (Mycobutin)
- substitute for rifampin in HIV patients taking indinavir, nelfinavir or amprenavir
- adjust rifabutin dose to minimize risk of drug interactions
- multidrug-resistant tuberculosis
- pyrazinamide & quinolone (ciprofloxacin) or ethambutol for 6-9 months
- pyrazinamide 15-30 mg/kg PO QD (max 2 grams/day) + levofloxacin 250 mg PO QOD for 9 months
- routine liver function testing no longer recommended except for patients with HIV, liver disease, chronic alcoholism or pregnant patients
- directly observed therapy for HIV-infected patients & homeless patients
- 5% of individuals with recent conversion of tuberculin skin testing (TST) will develop active disease within 1 year if left untreated.
- adequate treatment reduces risk of active disease
- risk of active disease after contact with TB is 1% within 4 years[12]
- number needed to treat: 88 to prevent 1 case of active tuberculosis[12]
More general terms
Additional terms
References
- ↑ Manual of Medical Therapeutics, 28th ed, Ewald & McKenzie (eds), Little, Brown & Co, Boston, 1995
- ↑ Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 183-86
- ↑ American Thoracic Society: Am J Crit Care Med 149:1359-1374 1994
- ↑ 4.0 4.1 4.2 Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 19. American College of Physicians, Philadelphia 1998, 2006, 2021.
- ↑ Prescriber's Letter 7(7):40 2000
- ↑ Kaiser Permanente, Northern California, Infection Control Update, 9/2000
- ↑ 7.0 7.1 7.2 Journal Watch 21(19):155, 2001 MMWR Morb Mort Wkly Rep 50:733, 2001
- ↑ 8.0 8.1 Prescriber's Letter 10(9):50 2003
- ↑ 9.0 9.1 9.2 Lardizabal A et al, Enhancement of treatment completion for latent tuberculosis infection with 4 months of rifampin. Chest 2006, 130:1712 PMID: https://www.ncbi.nlm.nih.gov/pubmed/17166986
Ashkin D et al, Consider rifampin BUT be cautious Chest 2006, 130:1638 PMID: https://www.ncbi.nlm.nih.gov/pubmed/17166975 - ↑ American Thoracic Society, Targeted Testing and Treatment of Latent Tuberculosis Infection, Am J Respir Crit Care Med 161:S221, 2000 http://www.atsjournals.org
- ↑ 11.0 11.1 CDC Press Release May 16m 2011 Session B9, oral presentation: Sterling, PREVENT TB: Results of a 12-Dose, Once-Weekly Treatment of Latent Tuberculosis Infection (LTBI) http://www.cdc.gov/nchhstp/newsroom/PREVENTTBPressRelease.html
Sterling TR et al Three Months of Rifapentine and Isoniazid for Latent Tuberculosis Infection N Engl J Med 2011; 365:2155-2166 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22150035 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1104875
Dye C Practical Preventive Therapy for Tuberculosis? N Engl J Med 2011; 365:2230-2231 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22150042 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMe1111859
Centers for Disease Control and Prevention Recommendations for Use of an Isoniazid-Rifapentine Regimen with Direct Observation to Treat Latent Mycobacterium tuberculosis Infection MMWR. December 9, 2011 / 60(48);1650-1653 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6048a3.htm
Prescriber's Letter 19(2): 2012 Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=280210&pb=PRL (subscription needed) http://www.prescribersletter.com - ↑ 12.0 12.1 12.2 Anger HA et al. Active case finding and prevention of tuberculosis among a cohort of contacts exposed to infectious tuberculosis cases in New York City. Clin Infect Dis 2012 May 1; 54:1287 PMID: https://www.ncbi.nlm.nih.gov/pubmed/22412056
- ↑ 13.0 13.1 Centers for Disease Control and Prevention (CDC). Recommendations for use of an isoniazid-rifapentine regimen with direct observation to treat latent Mycobacterium tuberculosis infection. MMWR Morb Mortal Wkly Rep. 2011 Dec 9;60(48):1650-3. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22157884
- ↑ Centers for Disease Control and Prevention Treatment for Latent TB Infection http://www.cdc.gov/tb/topic/treatment/ltbi.htm