Treatment of Latent Tuberculosis Infection

Abstract

None.

An update of management of latent tuberculosis infection and active disease in patients with chronic kidney disease

“…28 In a recent review and meta -analysis comparing different LTBI treatment regimens, those containing rifampicin for 3 months or more were potentially more efficacious in preventing active TB than isoniazid monotherapy. 23 This would support the view that at -risk patients on dialysis should be screened for LTBI and treated appropriately, whether or not they then proceed to a transplant, as the rifamycins can generally be used with fewer problems in patients not yet on immunosuppression for graft protection. Indeed, a prospective randomized controlled trial of isoniazid chemoprophylaxis during hemodialysis in a high -incidence country showed a significantly lower incidence of TB in the treated dialysis group compared with controls, with a risk ratio of isoniazid versus controls for the development of TB of 0.40 (95% CI, 0.17-0.92; P = 0.032).…”

“…23,24 One randomized study, however, did not report a problem with hepatotoxicity in 181 patients who received a 1 -year course of isoniazid after transplant in a high--incidence country. 26 Of the patients treated, one later developed TB, as compared with 16 of the 207 patients who were not treated (P = 0.0003).…”

“…4 The common regimens are: 6 (or 9) months of isoniazid, 300 mg/d, plus pyridoxine 4,23,24 ; 3 months of isoniazid and rifampicin based on weight (with pyridoxine); or 4 months of rifampicin alone, which seems to be better tolerated than isoniazid -containing regimens. 23,25 There should be no problem with the use of rifampicin in patients on hemodialysis and CAPD, but most centers prefer to use isoniazid alone in transplant recipients because of the interactions between the rifamycins and immunosuppressive agents used to prevent rejection.…”

“…23 Furthermore, the longer regimens are of rifamycins and concomitant immunosuppression. These drugs reduce the efficacy of steroids and other immunosuppressive agents such as mycophenolate mofetil, cyclosporine, and tacrolimus by the upregulation of cytochrome P450, and can result in an increased rate of graft rejection.…”

Effect of gene–gene and gene–environment interactions associated with antituberculosis drug-induced hepatotoxicity

“…Several surveys found that INH was primarily responsible for liver injury [8][9][10]. A recently published meta-analysis suggested that INH monotherapy led to higher rates of hepatotoxicity than RMP monotherapy [11]. Sarma et al [12] reported that combined INH and RMP treatment increased the risk of hepatotoxicity through the induction of amidase enzyme, which increased concentrations of a toxic metabolite of INH, hydrazine (Hz).…”