Pulmonology Book

http://www.fpnotebook.com/

Latent Tuberculosis TreatmentAka: Tuberculosis Prophylaxis, Tb Prophylaxis

Advertisement

  1. 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 to 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 of Treatment
    1. Typical course: 9-12 months
    2. Indications for 12 months of therapy
      1. Human Immunodeficiency Virus (HIV)
      2. Immunosuppression
      3. Chest XRay showing healed Tuberculosis
  4. Protocols for Latent Tuberculosis Treatment
    1. First Line Prophylaxis
      1. Isoniazid Routine Dosing
        1. Adults 300 mg PO qd for 9 months
        2. Child 10-15 mg/kg/day (max 300 mg/day) x9 months
      2. Isoniazid Alternative Dosing
        1. Adult: 900 mg twice weekly supervised (?effective)
    2. Alternative Protocols: Rifampin
      1. Rifampin 600 mg qd for 12 months
    3. Alternative Protocols: Rifampin and Pyrazinamide
      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
    4. Isoniazid Resistant Tuberculosis Exposure
      1. Rifampin 600 mg qd
      2. Ethambutol for 6-12 months
    5. 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
  5. Monitoring: Isoniazid toxicity
    1. Routine baseline Liver Function Tests not recommended
    2. Liver Function abnormalities exceed 3-5 times normal
    3. Obtain baseline and monthly Liver Function Tests if:
      1. History suggestive of Possible liver disorder
      2. Human Immunodeficiency Virus (HIV)
      3. Pregnancy
      4. Postpartum (within 3 months)
      5. Chronic Liver Disease
        1. Viral Hepatitis
        2. Alcoholic Hepatitis
        3. Cirrhosis

Navigation Tree