LTBI Prophylaxis is ONLY for those with_________________________.
no evidence of active disease
LTBI Prophylaxis Options include:
Isoniazid (INH) daily for 9 mo (6 months in otherwise healthy low risk patients)
COMBO of isoniazid (INH) and rifapentine (RPT) given in
12 once-weekly doses under DOT
Rifampin (RIF) given daily for 4 months (for people who cannot tolerate isoniazid (INH) or are exposed to isoniazid (INH)-resistant TB)
What is the interval and duration for Isonazid in the treatment for LTBI?
HIV: Daily for 9 months OR 2x week for 9 months with DOT
Adult, no fibrotic lesions, non-HIV: Daily for 6 months OR 2x week for 6 months with DOT
What is the interval and duration for Rifampin in the treatment for LTBI?
Daily for 4 months
What is the dose and interval for Isoniazid and rifapentine treatment for LTBI?
Once weekly for 3 months
Which should not take Isoniazid and rifapentine once weekly for LBTI?
<2 years old, HIV/AIDS patients taking antiretroviral treatment, isoniazid- or rifampin-resistant strains, pregnant women or women expecting to become pregnant within the 12-week regimen
Patients should be given ______________________________ of their completed treatment.
What adverse Events may occur during isoniazid (INH) therapy for LTBI prophylaxis?
Rarely, isoniazid (INH) can cause clinical signs of hepatitis; or of peripheral neuropathy
What are the S/S of Liver Toxicity caused by isoniazid (INH)?
No appetite / Nausea / Vomiting / Abdominal pain / Yellowish skin or eyes / associated itching / Dark urine
What baseline measurements should be done before starting Isonazid (INH) therapy?
How often should LFTs be performed when a patient is on isoniazid (INH)?
Baseline and 1-3 months
Monthly if elevations are seen, preexisting liver, or risk factors (pregnancy or postpartum, excessive alcohol intake)
How does Neuropathy caused by isoniazid (INH), present?
Numbness / tingling in extremities
_____________________are at increased risk for peripheral neuropathy, as are those with Pyridoxine (B6) deficiencies (pregnancy, alcoholics, some children and the malnourished).
Slow INH acetylators
_________________ agents may also occasionally cause hepatotoxicity, and can cause an “allergic” reaction that first appears with “flu like symptoms.”
Rifamycins (Rifampin, Rifabutin, Rifapentine)
What are the Rifamycins?
Rifampin, Rifabutin, Rifapentine
“allergic” type reaction seen more with intermittent use of Rifamycins > ________ mg
What are the 4 drugs most commonly used to treat active TB disease?
What is the dose and interval for Isonazid (INH), Rifampin (RIF), Pyrazinamide (PZA) and Ethambutol (EMB) in the INTIAL PHASE of ACTIVE TB treatment?
QD for 56 doses (8 weeks) or 5 days a week for 40 doses (8 weeks)
What is the dose and interval for Isonazid (INH) and Rifampin (RIF) in the CONTINUATION PHASE of ACTIVE TB treatment?
QD for 126 doses (18 weeks) or 5 days/wk for 90 doses (18 weeks)
Twice weekly for 36 doses (18 weeks)
What is the dose and interval for Isonazid (INH) and Rifapentine in the CONTINUATION PHASE of ACTIVE TB treatment?
Once weekly for 18 doses (18 weeks)
Treatment completion is determined by the______________________________.
number of doses taken over a given period of time
Treatment completion is not determined by ________________________________.
number of weeks or months on treatment
> _____ weeks for initial phase therapy.
> _____ weeks for continuation phase Tx.
Treating TB disease with _______drugs is more effective at killing all of the tubercle bacilli and helps to prevent drug resistance.
TB disease must be treated for at least ___ to ___months. In some cases, treatment can last much longer, for example, ___ to ___ months or longer to treat multidrug-resistant TB (MDR TB).
6 to 9
18 to 24
Regimens for treating TB have an initial phase of____________________, followed by a continuation phase of either ___ or ___ months.
2 months (8 weeks minimum)
4 or 7
Patients should be reevaluated if:
Symptoms do not improve after 2 months of therapy
Symptoms worsen after improving initially
Sputum Culture results are still positive after 2 months of treatment
Sputum Culture results become positive after being negative
What standard TB drugs are associated with: No appetite?
What standard TB drugs are associated with: Nausea?
What standard TB drugs are associated with: Vomiting?
What standard TB drugs are associated with: Yellowish skin or eyes?
What standard TB drugs are associated with: Abdominal Pain
What standard TB drugs are associated with: Skin Rash?
What standard TB drugs are associated with: Arthalgias?
What standard TB drugs are associated with: Flu like symptoms?
What standard TB drugs are associated with: Fever/Chills?
What standard TB drugs are associated with: Tingling fingers or toes?
What standard TB drugs are associated with: Blurred or changed vision?
_____________is typically discontinued if C & S shows TB susceptibility to the other three drugs (even before end of 8 weeks), due to its potential for____________.
___________can cause orange urine, saliva, or tears.
Rifampin can make people more sensitive to ___________.
___________makes birth control pills and implants less effective.
__________can cause withdrawal symptoms for patients taking _____________(used to treat drug addiction).
Persons who take ___________ and _____________may need their methadone dosages adjusted.
rifampin and methadone
DDIs must be considered whenever initiating therapy for TB patients, especially for those patients under concurrent treatment for___________.
What is extensively drug resistant tuberculosis (XDR TB)?
Resistant to isoniazid and rifampin, plus any fluoroquinolone and at least one of three injectable second-line drugs (i.e., amikacin, kanamycin, or capreomycin)
What is multidrug-resistant tuberculosis (MDR TB)?
An organism that is resistant to at least isoniazid and rifampin, the two most potent TB drugs
How does drug resistance happen?
When these drugs are misused or mismanaged, and other certain other circumstances. Examples include:
- Come from areas of the world where drug-resistant TB is common
- Have spent time with someone known to have drug-resistant TB disease
- Develop TB disease again, after having taken TB medicine in the past
- When patients do not take their TB medicine regularly, or do not complete their full course of treatment;
- When health-care providers prescribe the wrong treatment, the wrong dose, or length of time for taking the drugs;
- When the supply of drugs is not always available; or
- When the drugs are poor quality (counterfeit, stored under adverse conditions, etc).
How can MDR TB be prevented?
Take all of their medications exactly as prescribed
No doses should be missed and treatment should not be stopped early
Health care providers can help prevent MDR TB by:
quickly diagnosing cases,
following recommended treatment guidelines,
monitoring patients’ response to treatment, and
making sure therapy is completed
Which of the following drugs were used to treat Natalie’s MDR-TB in Personal Stories case?
p-Aminosalicylic Acid (Paser)
In the U.S., culture and sensitivity (C & S) results showing resistance will require a change from any drug for which there is resistance shown to _____________________replacement drugs for which the C & S shows organism susceptibility. This reduces risk of sequential resistance developing.
Two or more
Alternative Drugs used in the event of MDR-TB or XDR-TB include the following:
Linezolid has been used, as have other investigational drugs
What is the Vitamin that is often recommended to be used during INH Therapy?
Pyridoxine (Vit B6)
If the patient is placed on INH, and is________________, _______________ or _______________, they should also be given Pyridoxine (Vitamin B6) 10-50 mg daily during INH therapy to reduce risk of___________________________________.
pregnant, an alcoholic or had poor nutrition
CNS or peripheral neuropathy
Is there a vaccine to prevent TB? What is it called?
Yes, Bacille Calmette-Guéri (BCG Vaccine)
BCG is used in some countries to prevent:
Severe forms of TB in children
Why is the BCG vaccine not generally recommended in the United States?
Because it has limited effectiveness for preventing TB overall
What was reason given in Santos’ Personal Story for his failure to complete LTBI drug regimen?
Santos did not complete his treatment. Since Santos wasn’t feeling sick, he did not understand the importance of completing the full course of preventive treatment.
What topics should you counsel TB patients on?
Cause of TB
Diagnosis of TB
How to take medication
Side effects to medication
Measures to prevent the spread of TB (infection control)