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| The recommendations in this document
are intended to guide the treatment of tuberculosis in settings
where mycobacterial cultures, drug susceptibility testing,
radiographic facilities, and second-line drugs are routinely
available. In areas where these resources are not available, the
recommendations provided by the World Health Organization, the
International Union against Tuberculosis, or national tuberculosis
control programs should be followed. This Official Joint Statement
of the American Thoracic Society, CDC, and the Infectious Diseases
Society of America was approved by the ATS Board of Directors, by
CDC, and by the Council of the IDSA in October 2002. This report
appeared in the American Journal of Respiratory and Critical Care
Medicine (2003;167:603--62) and is being reprinted as a courtesy
to the American Thoracic Society, the Infectious Diseases Society of
America, and the
MMWR readership. |
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.
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Clinicians
Please Note:
QuantiFERON-TB Test
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