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Treatment of Tuberculosis Infection


- 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.