Pulmonology Book

http://www.fpnotebook.com/

Latent Tuberculosis TreatmentAka: Tuberculosis Prophylaxis, Tb Prophylaxis

Advertisement

  1. Indications: Strongest Indications for Latent Tuberculosis Treatment
    1. See Purified Protein Derivative for interpretation
    2. Human Immunodeficiency Virus (HIV)
    3. Child under 4 years old
    4. Close contact
    5. New PPD conversion within 2 years
    6. Risk of serious disease
      1. Miliary Tuberculosis
      2. Meningitis
  2. Contraindications: Latent Tuberculosis Treatment
    1. Age over 35 years (risk of hepatitis)
    2. Prophylaxis indications regardless of age
      1. Recent PPD conversion
      2. Chest XRay shows healed Tuberculosis
      3. Immunocompromised patient (e.g. HIV)
  3. Duration: Treatment
    1. Typical course: 9 months
    2. Course of 9 months is now also recommended in cases previously treated for 12 months
      1. Human Immunodeficiency Virus (HIV)
      2. Immunosuppression
      3. Chest XRay showing healed Tuberculosis (e.g. apical fibronodular changes)
  4. Protocols: Latent Tuberculosis Treatment
    1. See Isoniazid for specific precautions and Vitamin B6 supplementation guidelines
    2. First Line Prophylaxis
      1. Isoniazid Routine Dosing
        1. Adults 300 mg orally daily for 9 months
        2. Child 10-20 mg/kg/day (max 300 mg/day) for 9 months
      2. Isoniazid Alternative Dosing
        1. Adult: 900 mg twice weekly supervised (15 mg/kg)
        2. Child: 20-40 mg/kg twice weekly (maximum 900 mg)
    3. Alternative Protocols: Rifampin
      1. Do not use as monotherapy in HIV Infection
      2. Allows for shorter course and lower hepatotoxicity risk
      3. Review drug interactions before use
      4. Very expensive (10-20 times the cost of Isoniazid)
      5. Rifampin Routine Dosing (intermittent dosing not recommended when used alone)
        1. Adults 600 mg orally daily for 4 months
        2. Child 10-20 mg/kg/day (max 600 mg/day) for 6 months
  5. Protocols: Resistant Exposures
    1. Isoniazid Resistant Tuberculosis Exposure
      1. Rifampin 600 mg qd
      2. Ethambutol for 6-12 months
    2. Multi-drug resistant Tb Exposure:
      1. Pyrazinamide 25-30 mg/kg/day and
      2. Ethambutol 15-25mg/kg/day and
      3. Fluoroquinolones
        1. Ofloxacin 400mg bid or
        2. Ciprofloxacin 750 mg bid
  6. Protocols: Discontinued - Rifampin and Pyrazinamide
    1. No longer recommended for latent Tuberculosis treatment due to hepatotoxicity
    2. Details listed for historical purposes only
      1. Rifampin 600 mg qd for 2 months
      2. Pyrazinamide 25mg/kg qd for 2 months
    3. Higher risk of hepatotoxicity than with 6 months INH
      1. Observe serial Liver Function Tests closely
      2. Jasmer (2002) Ann Intern Med 137:640
  7. Monitoring
    1. See Isoniazid for toxicity related to Neuropathy and Hepatotoxicity
    2. See Rifampin regarding drug interactions

Navigation Tree