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Avatar universal

Active TB Prevention

Hi, I had a positive PPD a couple of years ago and I was placed on the regular INH, but the only problem was I was not advised and I did not take the time to research. So I did not follow my regime fully. I'm pretty sure that I took it without fail for at least 3 months. However after that I can't remember how many I may have missed. I do know for a fact that I eventually finished it. I cause I had to get the usual liver test, you know.
So my questions are what are my options? I currently work in a health care setting. Am I INH resistance now? Is there a sure way to tell? Is there a other type of prophylactic that I can take, like may something offered to pts. who are allergic to INH? Should I be worried, I do not have any immune problems, I am young 24+...would really love some advice. THANKS
1 Responses
Avatar universal
Dear Jbanks_7,

Great question.

Based on a literature review, there is one study that gets close to addressing your question.

Reference: International Union against Tuberculosis Committee on Prophylaxis. Efficacy of various durations of isoniazid preventive therapy for tuberculosis: Five years of follow-up in the IUAT trial. Bull World Health Organ; 1982;60:555-64.

"Among patients who took more than 80 percent of the prescribed doses, the 6-month regimen decreased the incidence of active tuberculosis by 69 percent and the 12-month regimen reduced the incidence by 93 percent, as compared with the 3-month regimen." from N Engl J Med, Vol. 345, No. 3 July 19, 2001.

The risk of going on to developing "reactivation tuberculosis" (also called post-primary tuberculosis) decreases dramatically each year after a tuberculosis skin test (TST) is positive. This is true with or without treatment. Obviously, the risk is diminished to a much greater extent with treatment with INH.

Have you had a chest radiograph (x-ray)? When? What were the results?

It is difficult to say if you may have fostered INH resistance because of your inconsistence adherence to the therapy. There is no way to determine whether you may have fostered INH resistent latent tuberculosis.

If you have had a chest radiograph and it was negative, if you are asymptomatic, and if you have no reason to be in an immunocompromised state (HIV/AIDS, status post transplant, taking corticosteroids, etc), then I would recommend that you be followed annually with a tuberculosis questionnaire (asks about symptoms).

Symptoms that you should be concerned about:
* “Have you had a cough for more than 3 weeks?”
* “Have you had night sweats?’
* “Have you experienced unintentional weight loss of more than 10 pounds in the last 2 months?”
* “Have been coughing up blood or mucous?”
* “Have you had contact with anyone with the symptoms described above?”

A caveat, there are some settings (military, laboratory workers working with susceptible animal populations, some health care workers) in which you would be advised to repeat a course of nine months of INH. I do not necessarily recommend this in your case.

Lastly, there are 2 alternative regimens to INH.

1. Pyrazinamide + rifampin   x 2 months

2. Rifampin  x 4 months (if the person cannot tolerate pyrazinamide)

I hope this is helpful.

~*~ Dr. Parks

This answer is not intended as and does not substitute for medical advice. The information presented in this posting is for patients’ education only. As always, I encourage you to see your personal physician for further evaluation of your individual case.
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