Alaska Tuberculosis Program Manual - Epidemiology - State of Alaska
Alaska Tuberculosis Program Manual - Epidemiology - State of Alaska Alaska Tuberculosis Program Manual - Epidemiology - State of Alaska
LTBI Treatment Regimens Table 4 RECOMMENDED DRUG REGIMENS FOR TREATMENT OF LATENT TUBERCULOSIS INFECTION IN CHILDREN 20 Drug Isoniazid (INH) Rifampin (RIF) Interval and Duration Daily for 9 months Twice weekly for 9 months Daily for 6 months in children Comments In HIV-infected patients, INH may be administered concurrently with nucleoside reverse transcriptase inhibitors (NRTIs), protease inhibitors, or non-nucleoside reverse transcriptase inhibitors (NNRTIs). Rating * (evidence) † HIV– HIV+ A (II) A (II) DOT must be used with twice-weekly dosing. B (II) B (II) RIF is ONLY used for children who are contacts of patients with INH-resistant, RIF-susceptible TB or for persons who do not tolerate isoniazid therapy. In HIV-infected patients, Rifampin may interfere with some antiretroviral drugs. Expert consultation is advised. The optimal length of RIF therapy in children with LTBI is not known; however, the American Academy of Pediatrics recommends 6 months of treatment. 21 B (II) B (III) Definitions of abbreviations: DOT = directly observed therapy; HIV = human immunodeficiency virus; LTBI = latent tuberculosis infection;. * Strength of recommendation: A = Preferred, B = Acceptable alternative, C = Offer when A and B cannot be given. † Quality of evidence: I = Randomized clinical trial data, II = Data from clinical trials that are not randomized or were conducted in other populations, III = Expert opinion Source: Adapted from CDC. Targeted tuberculin testing and treatment of latent tuberculosis infection. MMWR 2000;49(No. RR- 6):31. Table 5: RECOMMENDATIONS AND CONSIDERATIONS FOR USING THE 12-WEEK ISONIAZID-RIFAPENTINE REGIMEN 22 Consider the regimen for: Regimen is NOT recommended for: Comments: Healthy persons 12 years or older Recently exposed contacts of infectious TB and new TB converters Persons with radiographic findings of healed pulmonary TB HIV infected persons who are not taking antiretroviral medications Children younger than 2 years of age People with HIV/AIDS who are taking antiretroviral treatment People presumed to be infected with INH or RIF-resistant M. tuberculosis Pregnant women or women expecting to become pregnant within the 12–week treatment Individuals who had prior adverse events or hypersensitivity to rifampin Therapy may be considered in children ages 2-12 on a case by case basis Source: CDC. Recommendations for Use of an Isoniazid-Rifapentine Regimen with Direct Observation to Treat Latent Mycobacterium tuberculosis Infection. MMWR 2011; 60(48); 1650-1653. A L A S K A T U B E R C U L O S I S P R O G R A M M A N U A L Diagnosis and Treatment of LTBI and TB Disease in Children 9.14 R e v i s e d N o v e m b e r 2 0 1 2
For consultation regarding the treatment of LTBI, call the Alaska TB Program at 907-269-8000. Expert consultation with a pediatric TB specialist should be obtained for children judged to be infected with a multidrug-resistant strain of M. tuberculosis or HIV. Children who are at especially high risk for TB, and either are suspected of nonadherence or are on an intermittent (e.g. twice weekly) dosing regimen, should be treated using DOT. This method of treatment is especially appropriate when a household member is on DOT for TB disease or in institutions and facilities (schools) where a staff member can observe treatment. A L A S K A T U B E R C U L O S I S P R O G R A M M A N U A L Diagnosis and Treatment of LTBI and TB Disease in Children 9.15 R e v i s e d N o v e m b e r 2 0 1 2
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For consultation regarding the treatment <strong>of</strong> LTBI, call the <strong>Alaska</strong> TB<br />
<strong>Program</strong> at 907-269-8000.<br />
Expert consultation with a pediatric TB specialist should be obtained for<br />
children judged to be infected with a multidrug-resistant strain <strong>of</strong> M.<br />
tuberculosis or HIV.<br />
Children who are at especially high risk for TB, and either are<br />
suspected <strong>of</strong> nonadherence or are on an intermittent (e.g. twice<br />
weekly) dosing regimen, should be treated using DOT. This method <strong>of</strong><br />
treatment is especially appropriate when a household member is on DOT<br />
for TB disease or in institutions and facilities (schools) where a staff<br />
member can observe treatment.<br />
A L A S K A T U B E R C U L O S I S P R O G R A M M A N U A L Diagnosis and Treatment <strong>of</strong> LTBI and TB Disease in Children 9.15<br />
R e v i s e d N o v e m b e r 2 0 1 2
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