Isoniazid (INH): regimen
9 month (preferred) 270 doses w/in 12 months - effective for HIV infected - can be given 2x weekly via DOT (76 doses w/in 12 months) - preferred kids 2-11 y/o
6 month (acceptable) 180 doses w/in 9 months - can be given 2x/week via DOT (52 doses w/in 9 months) - not recommended for kids, immunosuppressed, CXR suggests previous TB
Isoniazid (INH): adverse reactions
- peripheral neuropathy (give Vitamin B6)
- fatal hepatitis (pregnant/postpartum at higher risk)
- elevated liver enzymes ( d/c if >3x normal w/ symptoms or 5x w/o symptoms)
INH-rifapentine regimen
given in 12 once weekly doses under DOT
- offers equal option to 9 months daily INH but doesn’t replace other tx options for LTBI
- pts should be monitored monthly for SE/adverse effects
INH-rifapentine is recommended for ?
treating LTBI in otherwise healthy people >12 y/o who had:
- recent contact w/ infectious TB
- TB skin test conversion
- positive blood test for TB infection
can be considered for specific groups that would benefit from need to complete tx in short time
INH-rifapentine is NOT recommended for ?
- kids <2 y/o
- HIV infected
- on ART drugs
- pts w/ presumed INH or RIF resistance
- women who are or might become pregnant
Recommendations against the RIF/PZA regimen
- no longer recommended d/t severe liver injury
- PZA (pyrazinamide) should NOT be offered to people w/ LTBI but should continue to be included in multidrug regimens for tx of TB disease
Rifampin (RIF) regimen
as alternative to INH
- 4 months daily OR 120 doses w/in 6 months
should no the used in HIV being treated w/ some ART
Rifabutin can be substituted if RIF cannot be used
LBTI treatment regimen for pregnancy and breast feeding
- 9 mths of INH daily or 2x weekly - give w/ Vitamin B6
- if cannot take INH consult TB expert
- 12 dose INH-RIF regimen not recommended (safety in pregnancy not known)
- women at high risk for progression to TB disease especially HIV/DM should NOT delay LTBI tx (monitor carefully)
- breastfeeding not contraindicated
gold standard for confirming diagnosis of TB
CULTURE
- culture all specimens even if smear of NAA negative
- results in 4-14 days when liquid medium systems used
- culture monthly until conversion (2 consecutive negative cultures)
candidates for treatment of LTBI:
high risk w +IGRA or TST >5mm
- HIV
- recent contact person w/ infectious TB
- fibrotic changes on CXR (previous TB)
- organ transplant/immunosupressed
candidates for treatment of LTBI:
high risk w +IGRA or TST >10mm
- immigrants from high prevalence areas (Asia, Africa, E. Europe, Latin America, Russia)
- IV drug user
- resident/employee high risk settings (jail, homeless shelter, hospital, nursing homes)
- mycobacterium lab personel
