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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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