Treatment of Latent TB

[rocketbooster]

Had a question in my studying about a healthcare worker with 5 previous negative PPD tests who now has a positive PPD test (11mm induration). CXR is normal. It asks what the next step in management is.

It has the options of to give BCG vaccine, treat with isoniazid, treat with rifampin, no treatment now and repeat PPD, no treatment now and repeat CXR annually. Which is it?

I chose rifampin and got it wrong. Don't know the correct answer. I could have sworn you treat a positive PPD test with normal CXR with one antibiotic vs. 4 antibiotics if it's active disease. According to the CDC (http://www.cdc.gov/tb/publications/LTBI/treatment.htm), you can use rifampin or isoniazid for treatment. It says to use rifampin if you cannot tolerate INH or if it is resistant to INH. The question doesn't say anything about resistance so not sure on that. Or perhaps you don't treat and either repeat the test or CXR (don't think so)? Thanks!

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[loveoforganic2]

My understanding - INH is 1st line for latent TB. RIPE(S) therapy is 1st line for active primary or reactivation TB (not latent). I think the CXR here is mostly to r/o active TB (i.e. the tx plan is either going to INH or RIPE depending on the film), but I may be wrong on that last part

 

[EBTrailRunner]

INH for 9 months.

 

[Kaustikos]

Rifampin is only used as a prophylactic/initially for Meningitis. Or for Leprosy with Dapsone to reduce/delay resistance. Or prophylactic for H.Inf type B. INH is the first line treatment for TB.

 

[mirimonster]

I just had a positive ppd (13 mm) after previous negatives with normal CXR and I definitely did not receive any treatment.

 

[gravitywave]

As was said, positive PPD means latent TB and is an indication to get CXR to rule out active disease. Negative CXR means nine months of INH unless known exposure to INH-resistant bugs or you don't tolerate it, in which case you get four months of rifampin instead. I know, feels weird to give rifampin all by itself but that's what the guidelines are.

 

[Kaustikos]

I just had a positive ppd (13 mm) after previous negatives with normal CXR and I definitely did not receive any treatment.

... I'm sure the CDC would completely agree with that hospitals decision.

 

[jdh71]

As was said, positive PPD means latent TB and is an indication to get CXR to rule out active disease. Negative CXR means nine months of INH unless known exposure to INH-resistant bugs or you don't tolerate it, in which case you get four months of rifampin instead. I know, feels weird to give rifampin all by itself but that's what the guidelines are.

It's not weird to give rifampin by itself. It's probably/arguably the BEST TB drug in the mainline arsenal. It's not given by itself first line to treat latent for risk of creating resistance.

 

[siliso]

I just had a positive ppd (13 mm) after previous negatives with normal CXR and I definitely did not receive any treatment.

...Well, you probably ought to get a new doctor. And some INH.