Back

Tuberculosis Protocol / Guidelines

Amy Murdock, RN
Program Coordinator  (360) 679-7351 x7272

return to ICPH              

Home

Community & Family Health
(nursing)

Top

Top

The American Thoracic Society (ATS) and the Centers for Disease Control and Prevention (CDC) have published their new recommendations for the screening and treatment of latent tuberculosis infection (LTBI). Last updated in 1999, these guidelines form the backbone of practice for tuberculosis (TB) prevention and control in the United States. The recommendations, published in the American Review of Respiratory and Critical Care Medicine (2000:161"S221-S247) and Morbidity and Mortality Report (2000:49[RR06] 1-54), have also been endorsed by the Infectious Diseases Society of America and the American Academy of Pediatrics.

Important changes in the new recommendations are outlined in Table 1*. The two most notable changes are: 1) the inclusion of persons age >35 in their recommendation to offer preventive therapy to all persons who are considered to have a positive PPD, regardless of age; and, 2) extending the duration of therapy for most persons from six months to nine months. The Health Department Anti-Tuberculosis Program provides screening and follow-up oversight for LTBI, including directly observed preventive therapy, as well as oversight of patients with active TB. Further information on screening for LTBI, diagnosis of active TB, or other TB related topics may be obtained by calling the Health Department Anti-tuberculosis Program at 360 679-7351. 

*Table 1.      Summary of changes included in the revised ATS/CDC Recommendations for Targeted Tuberculin Testing and Treatment of Latent Tuberculosis Infection.

Tuberculin testing ...

Emphasis on targeted tuberculin (PPD) testing among all persons, regardless of age, at high risk for recent LTBI or with clinical conditions that increase the risk of active TB

Tuberculin testing among persons at lower risk is discouraged

A tuberculin test (PPD) conversion is defined as an increase of >10 mm of induration within a 24 month period, regardless  age

For patients with solid organ transplants and other immunosuppressed conditions (i.e., receiving the equivalent of >15 mg/day of prednisone for > 1 month), a positive PPD is now defined as >5 mm rather than >10 mm

Treatment of LTBI ...

For HIB negative adults, isoniazid given for 9 months is preferred over 6 month regimens

For HIV infected persons or those with chest radiograph evidence of old, inactive TB, isoniazid should be given for 9 rather than 12 months

For HIV infected persons or those with chest radiograph evidence of old, inactive TB, isoniazid should be given for 9 rather than 12 months

For all persons with LTBI, a 2 month regimen of pyrazinamide and rifampin is acceptable

For all persons with LTBI, a 4 month regimen of rifampin is acceptable

Clinical and Laboratory monitoring ...

Routine Laboratory monitoring of most persons with LTBI can be eliminated. Monitoring should be performed during pregnancy or the immediate postpartum period, and in those with HIV infection, chronic liver dysfunction, or regular alcohol use

Clinical monitoring for signs and symptoms of possible adverse effects is emphasized, with prompt evaluation and changes in treatment as indicated.

Clinicians
Please Note:

Latent TB; Current Recommendations
    (MMR)

QuantiFERON-TB Test

History of Tuberculosis Chemotherapy

Chemotherapy Today

The Recent TB Epidemic

"Direct Observed Therapy" (DOT)

edited 24 Apr 2008
ICPH web control

Island County Public Health
6th & Main, P.O. Box 5000
Coupeville, WA 98239
Privacy & Disclaimer Statement