- Management:
- preventive therapy with Insoniazid given for 6-12 months is effective in decreasing the risk of future tuberculosis;
- persons for whom preventitive therapy is indicated include: household members and other close contacts of potentially infectious persons;
- newly infected persons; persons with past Tuberculosis or with a significant tuberculin reaction and abnormal chest films in whom current TB has been excluded;
- infected persons in special clinical situations such as sillicosis, diabetes mellitus, adrenocorticosteroid therapy.
- in persons younger than 35 years of age, routine monitoring of adverse effects of Isoniazid should consist of monthly symptom review;
- for persons 35 and older, in addition to monthly symptom reviews, hepatic enzymes should be measured prior to starting INH and periodically through out treatment;
- persons at high risk of developing severe forms of tuberculosis, if infected due to contact with a person having INH resistant organisms, should be treated with Rifampin rather than INH;
- 6 mo reginmen consisting of Isoniazid, Rifampin, and Pyrazinamide given for 2 months, followed by Isoniazid and Rifampin for 4 months is effective treatment in patients with fully susceptible organisms who comply with the treatment regimen.
- may be advisable to include Ethambutol in initial phase when Isonniazid resistance is suspected;
- 9 month regimen consisting of Isoniazid and Rifampin is also highly successful;
- need for additional drug in initial phase is not certain unless Isoniazid resistance is suspected;
- in this case, Ethambutol should be included until suseptibility tests have been reported;
- children should be treated in essentially the same way as adults using appropriately adjusted doses of the drugs.
- consideration must be given to the important differences in the approach to management in children.