(1) Targeted tuberculin testing and treatment of latent tuberculosis infection. (2) Update: fatal and severe liver injuries associated with rifampin and pyrazinamide for latent tuberculosis infection, and revisions in American Thoracic Society/CDC recommendations--United States, 2001. (3) Update: adverse event data and
(1) Targeted tuberculin testing and treatment of latent tuberculosis infection. (2) Update: fatal and severe liver injuries associated with rifampin and pyrazinamide for latent tuberculosis infection, and revisions in American Thoracic Society/CDC recommendations--United States, 2001. (3) Update: adverse event data and revised American Thoracic Society/CDC recommendations against the use of rifampin and pyrazinamide for treatment of latent tuberculosis infection--United States, 2003.
1st August 2003
Centers for Disease Control and Prevention - Federal Government Agency [U.S.]
Summary,
Centers for Disease Control and Prevention - Federal Government Agency [U.S.]
Summary,
GUIDELINE OBJECTIVE(S)
* To provide new recommendations for targeted tuberculin testing and treatment regimens for persons with latent tuberculosis infection (LTBI)
* To update previously published guidelines:
American Thoracic Society, Centers for Disease Control. 1994. Treatment of tuberculosis and tuberculosis infection in adults and children. Am J Respir Crit Care Med 149:1359-1374.
Centers for Disease Control and Prevention. 1995. Screening for tuberculosis and tuberculosis infection in high-risk populations: recommendations of the Advisory Council for the Elimination of Tuberculosis. MMWR Morb Mortal Wkly Rep 44(No. RR-11):19-34.
TARGET POPULATION
Persons at high risk for developing tuberculosis who would benefit by treatment of latent tuberculosis infection (LTBI), if detected:
* Persons who have had recent infection with mycobacterium tuberculosis
* Persons who have clinical conditions that are associated with an increased risk for progression of latent tuberculosis infection to active tuberculosis (i.e., human immunodeficiency virus [HIV] infection, weight loss of greater than 10 percent ideal body weight, silicosis, diabetes mellitus, chronic renal failure/hemodialysis, gastrectomy, jejunoileal bypass, solid organ transplantation, carcinoma of head or neck, radiographic findings consistent with prior tuberculosis, injection drug use)
INTERVENTIONS AND PRACTICES CONSIDERED
1. Targeted tuberculin skin testing for latent tuberculosis infection (LTBI) with purified protein derivative (PPD)
2. Diagnostic exclusion of active tuberculosis by clinical history, physical examination, chest radiography, and, when indicated, bacteriologic studies
3. Treatment of latent tuberculosis infection
* Isoniazid, daily for 9 months or twice weekly for 9 months
* Isoniazid, daily for 6 months or twice weekly for 6 months
* Rifampin, daily for 4 months
* NOTE: rifampin plus pyrazinamide was considered but not recommended
MAJOR OUTCOMES CONSIDERED
* Sensitivity and specificity of the intradermal or Mantoux PPD (purified protein derivative) tuberculin skin test reactions
* Efficacy of drug treatment regimens in preventing tuberculosis:
o 5-year tuberculosis incidence
o tuberculosis morbidity rate
o adverse events
