Tuberculosis

Latent Tuberculosis Infection Treatment Guidelines

By February 17, 2016 July 11th, 2018 No Comments

High-Priority Candidates for Latent Treatment Infection (LTBI) Treatment

Positive QuantiFERON-TB Gold (QFT) (>0.35 IU)

Tuberculosis Skin Test (TST) ≥5 mm

  • HIV-positive people.
  • Recent contacts of person with infectious tuberculosis (TB).
  • People with fibrotic changes on chest x-ray (CXR) suggestive of previous TB; or inadequate treatment.
  • People with organ transplants or immunosuppression therapy.

TST ≥10 mm

  • Recent arrivals (less than five years) from endemic areas.
  • Substance abusers.
  • Residents/employees of healthcare, correctional or long-term care facilities.
  • Children and adolescents exposed to high-risk adults.
  • People at high risk for certain medical conditions.

Conditions that Increase the Risk of Tuberculosis Disease

  • Diabetes mellitus.
  • HIV infection.
  • Substance abuse.
  • TST converter (≥10mm increase in TST in past 24 months).
  • Prolonged corticosteroid therapy or other immunosuppressive therapy.
  • End-stage renal disease.
  • CXR findings suggestive of previous TB in persons inadequately treated.
  • Cancer of head and neck.
  • Hematologic and reticuloendothelial disease.
  • Intestinal bypass or gastrectomy.
  • Chronic malabsorption syndromes.
  • Silicosis.
  • Low body weight (10% or more below ideal).
  • Recent contact to person with infectious TB.
  • Infants and children younger than five years with known positive TST.

Possible Contraindications

  • People at high risk for adverse reactions to isoniazid (INH).
  • People who cannot tolerate INH.
  • People likely to be infected with drug-resistant M. tuberculosis.
  • People highly unlikely to complete a course of therapy.

Use Caution When Prescribing LTBI Treatment for People Who:

  • Abuse alcohol.
  • Are on hormonal contraceptives.
  • Are pregnant.
  • Inject drugs.
  • Currently use other medications that may interact.
  • Have chronic liver disease.
  • Have or are at risk for peripheral neuropathy.
  • Have a history of adverse reactions to LTBI medications.

Centers for Disease Control and Prevention (CDC) Preferred Regimen

1. ISONIAZID (INH).

  • Adults need nine months of therapy; 5 mg/kg/day, not to exceed 300 mg/day.
  • Children need nine months of therapy; 10-15 mg/kg/day, not to exceed 300 mg/day.

Please consider pyridoxine 50 mg daily to reduce symptoms of vitamin B deficiency.

Alternate Regimens

2. RIFAMPIN (RIF).

  • Adults need four months of therapy: RIF—10 mg/kg/day, not to exceed 600 mg/day.
  • Children need four months of therapy: RIF—10 to 20 mg/kg/day, not to exceed 600 mg/day.

3. INH + RIFAPENTINE.

Patient Education

  • Will need monthly visits (all regimens).
  • Educate on signs and symptoms of hepatitis.
  • Rifampin discolors urine.
  • Rifampin may interfere with anticoagulant therapy, reduces the efficacy of hormonal contraceptives.
  • Educate on symptoms of neurotoxicity.

Monitor Monthly

Monitor LTBI treatment patient for:

  • Adherence to the prescribed regimen.
  • Signs and symptoms of hepatitis.
  • Symptoms of neurotoxicity.

Dispense no more than one month supply of medication at one time.

Questions? Contact Yakima Health District at (509) 575-4040 or (800) 535-5016.