Chapter 29: Tuberculosis
JK is a 32-year-old HIV-negative patient presenting to your clinic. He receives a Mantoux skin test that returns positive 2 days later. He was born in the United States and works as a prison guard. He injects heroin on a regular basis. His chest x-ray comes back normal, he has no symptoms of tuberculosis, and his smear culture is negative. What type of drug therapy would be appropriate for this patient?
a. Isoniazid 300 mg daily × 9 months
b. Rifampin 100 mg daily × 4 months
c. No drug therapy needed
d. Isoniazid 300 mg and rifampin 600 mg × 6 months
e. Isoniazid, rifampin, ethambutol, and pyrazinamide
Answer a is correct. The patient does not have any symptoms or indications of active TB disease; so he needs treatment for latent TB infection. This is the correct first-line regimen for treatment of latent TB infection.
Answer b is incorrect. Rifampin is a second-line treatment for latent TB infection. It can be used in patients with intolerance to isoniazid or in areas where isoniazid-resistant strains of TB are prevalent. The dose of rifampin is also too low.
Answer c is incorrect. Treating latent TB infection significantly reduces his risk of converting to active disease. He works in a high-risk setting prison where if he were to get active disease it could be spread more easily as well.
Answer d is incorrect. Latent TB infection typically only requires monotherapy.
Answer e is incorrect. Latent TB infection typically only requires monotherapy. This four-drug regimen is used in treating active TB disease.
BCG vaccine should be routinely given to which patient in the United States?
e. BCG vaccine is not routinely recommended in the United States
Answer e is correct. BCG vaccination should not be routinely given to any specific age group in the United States.
Answers a, b, c, and d are incorrect. BCG vaccination should not be routinely given to any specific age group in the United States.
RS is a 25-year-old Hispanic woman who is recently diagnosed with active tuberculosis. Her physician asks what drug regimen you would recommend to treat her disease? She does not have any contraindications ...