TB Flashcards
Risks for Activation
-HIV
-Immunosuppression (CS/chemo)
-Stress
-Organ transplants
-Malnutrition
SHOMI
Active vs Latent Tx
Latent
-Use single drug, dual therapy can shorten tx
-Culture neg
-PPD, IGRA
Active
-Multidrug regimen, 3+
-Culture pos
-Skin test, x-ray
Screening
-Exposure/contact
-Lab personnel
-High burden countries
-Homeless, jail
-Healthcare workers
-HIV, IC, children < 5, comorbidities
Active TB Tx
First Line: RIPE
-Rifampin 8->18
-Isoniazid 8->18
-Pyrazinamide 8
-Ethambutol 2->6
MDR Strains: BCCALL
-Levo/moxi
-Amikacin
-Linezolid
-Cyclosporine
-Clofazimine
-Bedaquiline
Rifampin
10 mg/kg/day
Empty stomach
AE: TO STAPLE
-Orange/red bodily fluids
-Hepatoxicity
-Pulmonary tox
-Rash (SJS, TENS)
-Hemolytic anemia
-NVD
DDI:
-CYP/PGP
Other Rifs
Rifabutin
-can replace rifampin within RIPE to avoid DDIs
Rifapentine
-same as above, has least DDIs out of all 3
Isoniazid
5 mg/kg
Empty stomach
AE: IS FONT TEA HA
-Hepatitis (BBW)
-Neuropathy (give with pyridoxine, B6)
-Anemia
-Thrombocytopenia
-Agranulocytosis
-Rash (TENS)
-Optic neuritis
Pyrazinamide
1-4 g QD->3x/W
*CrCl < 30: 3x/W
With or w/o food
AE: PY pie HAM NUM
-Hepatotoxicity
-Malaise
-NV
-Hyperuricemia
-Arthralgia, myalgia
Ethambutol
800-4000 mg QD->3x/W
With or w/o food
AE: e YOUL CHOP
-Ophthalmic tox
-Confusion, HA, dizzy, hallucination
-Hepatoxicity
-Hypersensitivity
-Pneumonitis
CI:
-Optic neuritis, young children, unconscious
Latent TB Tx
Preferred
-Rifampin 4 mo
-Iso + Rifampin 3 mo
-Iso + Rifapentine 3 mo (has to be under observed therapy)
Alt
-Iso 6-9 mo
Managing Hepatoxicity
If ALT >= 5x ULN +/- sx or >= 3x ULN + sx = Discontinue
-Can restart once < 2x ULN or near baseline
Mod elevated: increase frequency of labs
Risk for Resistance
-Take meds irregularly
-Don’t finish full course
-Get TB again after tx
-From area where resistant TB is common
-Contact with DR TB
Prevention
-Mask, isolation, neg pressure room
-BCG Vaccine (not rec in US)
