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Chapter 75. Tuberculosis

Student Questions

JC is a 45-year-old male who has a positive IFN-γ test and has been exposed to isoniazid-resistant TB during his travels. What LTBI treatment regimen should be recommended for this patient?

A. Isoniazid and rifapentine for 3 months

B. Isoniazid, rifampin, and ethambutol or pyrazinamide for 4 months

C. Rifampin for 4 months

D. Rifampin for 6 months

Answer: C

Option A: Incorrect. Typically isoniazid is used for treating LTBI but the strain is isoniazid resistant; therefore, isoniazid should not be included in the treatment regimen.

Option B: Incorrect. Typically isoniazid is used for treating LTBI but the strain is isoniazid resistant; therefore, isoniazid should not be included in the treatment regimen.

Option C: Correct. Rifampin 600 mg daily for 4 months can be used when isoniazid resistance is suspected or when the patient cannot tolerate isoniazid.

Option D: Incorrect. Rifampin for 6 months.

SP is a 40-year-old HIV positive man who has been diagnosed with TB. SP's TB treatment should:

A. Be delayed until the patient's CD4 count is more than 1000 cells/mm3 (109/L)

B. Continue for at least 6 months

C. Consist of higher doses of antituberculosis medications

D. Be initiated 6 months after antiretroviral therapy is started

Answer: B

Option A: Incorrect. Recent data support the early introduction of antiretroviral therapy (within 2 weeks of starting TB drugs) in patients with low CD4+ counts (≤ 50/mm3 [≤ 50 × 106/L]).

Option B: Correct. The recommended regimen for susceptible TB in HIV-infected adults is a 6-month regimen.

Option C: Incorrect. There is no evidence to justify treatment with higher doses of antituberculosis medications without TDM.

Option D: Incorrect. Treatment for HIV has been recommended to start after 2 months of TB treatment, although individual circumstances often dictate the exact timing.

An HIV-positive patient on a combined antiretroviral therapy (cART) regimen is seen in Infectious Disease Clinic for treatment of TB. The provider chose rifabutin over rifapentine or rifampin for the patient because it:

A. Has a better side effect profile in HIV-positive patients

B. Is less likely to induce hepatic clearance of the cART drugs

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