Unit 3 TB

Question 1

Isoniazid (INH): regimen

Answer 1

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

Question 2

Isoniazid (INH): adverse reactions

Answer 2

• 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)

Question 3

INH-rifapentine regimen

Answer 3

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

Question 4

INH-rifapentine is recommended for ?

Answer 4

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

Question 5

INH-rifapentine is NOT recommended for ?

Answer 5

• kids <2 y/o
• HIV infected
• on ART drugs
• pts w/ presumed INH or RIF resistance
• women who are or might become pregnant

Question 6

Recommendations against the RIF/PZA regimen

Answer 6

• 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

Question 7

Rifampin (RIF) regimen

Answer 7

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

Question 8

LBTI treatment regimen for pregnancy and breast feeding

Answer 8

• 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

Question 9

gold standard for confirming diagnosis of TB

Answer 9

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)

Question 10

candidates for treatment of LTBI:

high risk w +IGRA or TST >5mm

Answer 10

• HIV
• recent contact person w/ infectious TB
• fibrotic changes on CXR (previous TB)
• organ transplant/immunosupressed

Question 11

candidates for treatment of LTBI:

high risk w +IGRA or TST >10mm

Answer 11

• 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