New Guidelines for Treatment of Latent Tuberculosis Infection
Toma, Tudor, Bulletin of the World Health Organization
New guidelines on the testing and treatment of persons with latent tuberculosis infection have been issued by the American Thoracic Society (ATS) and the Centers for Disease Control and Prevention (CDC). Prepared by a panel of 47 scientists, the document suggests several important changes from previous guidelines and practices (American Journal of Respiratory and Critical Care Medicine, 2000, 161: 221-247).
After further analysis of earlier clinical trials, the new guidelines recommend nine months of daily treatment with isoniazid for adults with latent tuberculosis infection regardless of whether the patient is infected with human immunodeficiency virus (HIV). The document also strongly discourages widespread tuberculin screening or testing of persons at low risk of tuberculosis. Instead, targeted tuberculin testing is recommended for latent tuberculosis infection to identify individuals at high risk of tuberculosis who, if found to be infected, would benefit from the recommended treatment. Persons at highest risk include those with recent tuberculosis infection and those with clinical conditions that are associated with an increased risk for progression to active tuberculosis.
The guidelines include several criteria for different risk groups that define a positive tuberculin test. Children should be screened, if possible by use of a questionnaire, for risk factors for tuberculosis infection. Those at risk are candidates for tuberculin skin tests, which should be interpreted according to the criteria for adults with the exception that a reaction of greater than or equal to 10 mm of induration should be considered as a positive test in children of less than four years of age. …