Chapter 30. Tuberculosis
JK is a 32-year-old human immunodeficiency virus (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 shows 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 (LTBI). This is the correct first-line regimen for treatment of LTBI.
Answer b is incorrect. Rifampin is a second-line treatment for LTBI. 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 LTBI 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. LTBI typically only requires monotherapy.
Answer e is incorrect. LTBI typically only requires monotherapy. This four-drug regimen is used in treating active TB disease.
Bacillus Calmette–Guérin (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.
Answer a, b, c, and d are incorrect. BCG vaccination should not be routinely given to any specific age group in the United States.
RL is a 37-year-old man who presents to your pharmacy with a prescription for rifampin. His other medications include: acetaminophen 1000 mg four times daily, phenytoin 100 mg twice daily, warfarin 3 mg daily, and omeprazole 20 mg once ...