Treatment of latent TB

• If screening test ⊕ and no risk factors, confirm prior to treatment;
• if ⊕ w/ risk factors, proceed to treatment (CID 2017;64:11).
• Prior to treatment of latent TB, active TB must be ruled out with, at a minimum, ROS for symptoms (cough, fever, night sweats, weight loss), physical exam, and CXR (though may be normal in immunosupp.)

Scenario - Prophylaxis Regimen

PPD/IGRA ⊕ (regardless of HIV status)

• 1st line:
  • Rifampin × 4 mo or
  • INH/rifampin daily x 3 mos or
  • INH/rifapentine weekly × 12 wks) (MMWR 2020; 69:1)
• Alternative: INH + vitamin B6 × 6–9 mos

Contact case known or suspected to have MDR TB

• No proven regimen: ? PZA + EMB, ? PZA + FQ
• ✓ LFTs monthly if receiving INH
  • (risk ↑ w/ age; Chest 2005;128:116): if AST/ALT ↑ 5× ULN or sx (nausea, vomiting, abd pain)
    • → stop TB meds & re-eval