Treatment for Latent TB
Who should be considered for latent TB treatment? (1)
- persons that test positive for TB on the Mantoux or IGRA test and whose chest radiograph is negative for TB
- contacts of persons exposed to TB that are:
▪ a child younger than the age of 5
▪ immunosuppressed or at high risk of developing active TB if infected
Treatment is generally initiated based on laboratory drug susceptibility results, concomitant medical conditions and interactions with the medications that the patients are currently on.
If INH can be tolerated, it is generally the standard treatment for latent TB. INH is covered through the local Public Health and DOPT, or Directly Observed Prophylactic Therapy, can be offered if the patient is at risk of non-compliance. This medication can be prescribed as a 9 or a 6 month regimen with 93% and 69% protection, respectively. (2)
INH is not recommended in pregnant women (for the treatment of latent TB), unless they were infected
recently and they have HIV. Treatment should be postponed until the second trimester if the woman is still at high risk or until the postpartum period for all others. (2)
If INH can not be tolerated, a specialist has to be consulted before Rifampin can be prescribed. Side effects of INH include: peripheral neuropathy (should be taken with a vitamin B6 supplement), fetal hepatitis (especially in pregnant women), elevated liver enzymes . (2)
Similarly, Rifampin can cause hepatotoxicity, rash, and a flu-like illness. In addition, it may cause a stronger pigmentation (orange-red) of urine, sweat, tears, saliva, feces. This is not dangerous for the patient, however, it may permanently stain contact lenses. (2)
In the event that someone refuses treatment or is not able to follow it according to the instructions, he/she has to be followed up for 2 years. This is because this is the period during which they are at highest risk of developing active TB. The respective patients are also educated and instructed to report any symptoms of active TB. (2)
- persons that test positive for TB on the Mantoux or IGRA test and whose chest radiograph is negative for TB
- contacts of persons exposed to TB that are:
▪ a child younger than the age of 5
▪ immunosuppressed or at high risk of developing active TB if infected
Treatment is generally initiated based on laboratory drug susceptibility results, concomitant medical conditions and interactions with the medications that the patients are currently on.
If INH can be tolerated, it is generally the standard treatment for latent TB. INH is covered through the local Public Health and DOPT, or Directly Observed Prophylactic Therapy, can be offered if the patient is at risk of non-compliance. This medication can be prescribed as a 9 or a 6 month regimen with 93% and 69% protection, respectively. (2)
INH is not recommended in pregnant women (for the treatment of latent TB), unless they were infected
recently and they have HIV. Treatment should be postponed until the second trimester if the woman is still at high risk or until the postpartum period for all others. (2)
If INH can not be tolerated, a specialist has to be consulted before Rifampin can be prescribed. Side effects of INH include: peripheral neuropathy (should be taken with a vitamin B6 supplement), fetal hepatitis (especially in pregnant women), elevated liver enzymes . (2)
Similarly, Rifampin can cause hepatotoxicity, rash, and a flu-like illness. In addition, it may cause a stronger pigmentation (orange-red) of urine, sweat, tears, saliva, feces. This is not dangerous for the patient, however, it may permanently stain contact lenses. (2)
In the event that someone refuses treatment or is not able to follow it according to the instructions, he/she has to be followed up for 2 years. This is because this is the period during which they are at highest risk of developing active TB. The respective patients are also educated and instructed to report any symptoms of active TB. (2)
References
1. Ontario Lung Association. Tuberculosis. Information for
healthcare providers. 4th edition. http://www.on.lung.ca/document.doc?id=475. Updated 2009. Accessed May 10,2013
2. Ontario Lung Association. Tuberculosis. Information for healthcare providers. 4th edition. http://www.on.lung.ca/document.doc?id=475. Updated 2009. Accessed May 10,2013
Images
1.Cook VJ. Johnston JC. Infectious Diseases: Tuberculosis. E-therapeutics. https://www.e-therapeutics.ca/tc.showChapter.action?documentId=c0094#c0094n00001. Updated January 2013. Accessed May 10. 2013
1. Ontario Lung Association. Tuberculosis. Information for
healthcare providers. 4th edition. http://www.on.lung.ca/document.doc?id=475. Updated 2009. Accessed May 10,2013
2. Ontario Lung Association. Tuberculosis. Information for healthcare providers. 4th edition. http://www.on.lung.ca/document.doc?id=475. Updated 2009. Accessed May 10,2013
Images
1.Cook VJ. Johnston JC. Infectious Diseases: Tuberculosis. E-therapeutics. https://www.e-therapeutics.ca/tc.showChapter.action?documentId=c0094#c0094n00001. Updated January 2013. Accessed May 10. 2013