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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?

a. A 10-year-old child

b. A 2-month-old infant

c. A 65-year-old man

d. A 6-month-old infant

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 ...

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