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Second Chance - TB

Initial tx for TB include:

INH 5mg/kg (300mg max)

RIF 10mg/kg (600mg max)

PZA 20-25mg/kg (2 gram max)

EMB 15-20mg/kg (2 gram max)

When should TB meds be taken?

Once daily on empty stomach for 8 wks, then susceptibility testing

What to do if TB susceptible to INH, RIF, and PZA?

Can stop ethambutol at any time

Continue all 3 for total 6mo

When should tx be extended to 9 months?

Slow clinical response

Unable to use PZA due to resistance

Positive cultures at 2 mo

Isoniazid ADEs?

Increase LFTs

Hepatitis

Peripheral/optic neuropathy

Pyridoxine (vitamin B6) 50mg PO daily is taken with which TB drug?

PZA

INH

RIF

EMB

EMB ADEs? (avoid antacids)

Optic neuritis (vision screening monthly)

Cutaneous rxn

RIF ADEs?

Orange urine, sweat, tears

Increased LFTs

Flu-like sx

PZA ADEs?

Arthralgias

Hyperuricemia

Counseling points for bedaquiline fumarate

Do not use with RIF (CYP DDI)

What is a possible once-weekly option if cultures are (-) and HIV (-) after 2 mo, and no cavitation on initial CXR?

Isoniazid + Rifapentine once weekly for 18 weeks

Tx for latent TB?

INH 5mg/kg daily x 9mo (270doses total)

Treatment for latent TB reduces lifetime risk from 10% to 1%

True

False

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