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Category: Clinical Microbiology; Bacterial Pathogenesis
Treatment of Latent Tuberculosis Infection, Page 1 of 2
< Previous page | Next page > /docserver/preview/fulltext/10.1128/9781555817138/9781555815134_Chap06-1.gif /docserver/preview/fulltext/10.1128/9781555817138/9781555815134_Chap06-2.gifAbstract:
This chapter focuses on the treatment of persons with latent tuberculosis infection (LTBI) to prevent future development of TB disease. The identification and treatment of persons with LTBI constitute an essential component of TB elimination through two fundamental mechanisms. The first is the individual clinical benefit conferred through the prevention of morbidity and mortality associated with active TB disease. The second benefit is gained at the population level through the prevention of spread of Mycobacterium tuberculosis infection within the community and the associated reduction in health care spending. Prior to the initiation of treatment, all persons with evidence of LTBI should be evaluated for the presence of pulmonary and extrapulmonary TB disease, including a thorough review for TB symptoms, a clinical examination, and a chest radiograph. Specific LTBI treatment regimens are summarized in this chapter according to their effectiveness and level of tolerability. Adverse effects of LTBI treatment drugs such as isoniazid, rifampin and pyrazinamide are also listed in this chapter. To ensure that the maximal benefit of LTBI therapy is achieved, adherence to treatment should be monitored closely for all patients at the recommended monthly clinical visits. Cost-effectiveness is an important consideration for public health programs when determining the most appropriate LTBI treatment regimen to use for targeted testing and LTBI treatment outreach activities. Choosing the most appropriate LTBI regimen, clinical monitoring for potential adverse events, and utilization of adherence-promoting strategies to ensure completion are critical elements for the success of LTBI treatment to prevent additional TB disease.
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LTBI pretreatment clinical evaluation and counseling. Dotted lines signify management according to physician’s discretion. ALT, alanine aminotransferase; INR, international normalized ratio; PTT, partial thromboplastin time. Reprinted with permission of the American Thoracic Society ( 122 ).
Monitoring for hepatotoxicity during LTBI treatment. Dotted lines signify management according to physician’s discretion. ALT, alanine aminotransferase; AST, aspartate aminotransferase; HAV, hepatitis A virus; HCV, hepatitis C virus; HepBsAg, hepatitis B surface antigen. Reprinted with permission of the American Thoracic Society ( 122 ).
TB case rates in the Bethel Isoniazid Studies population according to the number of months that isoniazid was taken in the combined programs. Dots represent observed values; dashed line, the calculated curve (y = a + b/x); and dotted lines, the calculated values based on the first four and the last five observations (y = a + bx). Reprinted by permission of the International Union Against Tuberculosis and Lung Disease ( 27 ).
Effectiveness of three regimens for treatment of LTBI in elderly Chinese men with silicosis. Based on 503 patients at 1 year, 474 at 2 years, 418 at 3 years, 367 at 4 years, and 304 at 5 years who received their regimen without known interruption. The x axis shows the months from start of the LTBI treatment regimen. The y axis shows the percentage of patients who developed TB disease. HR3, isoniazid and rifampin for 3 months; H6, isoniazid for 6 months; Pl, placebo; R3, rifampin for 3 months ( 79 ). Reprinted with permission of the American Thoracic Society ( 54 ).
Relative risk of reactivation TB among persons with medical conditions that impair immune control of M. tuberculosisa
Placebo-controlled studies of isoniazid efficacy for treatment of LTBI a
Regimens for the treatment of LTBI a
Adverse effects of LTBI treatment drugs a
Predictors of adherence to LTBI medications a
Challenges of treatment adherence and possible solutions in patients with LTBI a
Treatment of MDR LTBI a