Tuberculosis (TB)

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Treatment for TB Infection

The reason for treating a patient with asymptomatic tuberculosis infection is that there is a 5% risk for developing TB during the first year after infection and an additional 5% risk for developing TB over a lifetime. Also, treatment of asymptomatic TB infection is much simpler than treating tuberculosis.

The size of induration (swelling) and the clinical setting affect the likelihood that a positive PPD skin test represents a real infection. For instance, 5 mm of induration is significant in someone who has had recent contact with active TB, but not in a person without risk factors. The main indications for preventive therapy for tuberculosis-infected patients include the following:

• PPD > 5 mm in the following patient groups:
• Adults and children with HIV infection
• Close contacts with infectious cases of TB
• Patients with fibrotic lesions on chest x-ray
• PPD > 10mm in the following patient groups:
• Adults and children at risk for developing TB
• Intravenous drug users
• Immigrants from countries where tuberculosis is prevalent
• Members of racial and ethnic minorites with an increasing incidence of tuberculosis
• Medically underserved persons


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• Residents of long term care facilities, including prisons, mental institutions, and nursing homes
• Patients with silicosis
• Post-gastrectomy patients
• Post-jejunoileal bypass patients
• Malnutrition
• Diabetes
• Chronic renal failure
• Immunosuppressive therapy (e.g., transplant patients)
• Workers in health care facilities, hospital microbiology laboratories, schools, and daycare facilities
• Children under age 4
• Patients over age 35 with an increase > 15 mm in the area of PPD over 2 years
• Patients under age 35 with an increase > 10 mm in area of PPD over 2 years
• Patients with HIV infection exposed to an active case of TB, regardless of PPD reaction

Isoniazid
Treatment lasts 6 months in an adult without HIV, 12 months in an adult with HIV, and 9 months in children. This drug has side effects.

Rifampin
This is the second most commonly used drug. Generally, the course of therapy with rifampin is 6 to 12 months. If a patient has been exposed to multidrug-resistant Mycobacterium tuberulosis, individualization of drug therapy is required. Side effects have been noted with this drug.

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