LTBI - Managing Patients

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Managing Patients

  • Rule out TB disease with an initial clinical examination, including symptom screen (for cough, fever, night sweats, weight loss, hemoptysis), chest radiograph, and other studies, as indicated, before starting LTBI treatment.
  • Consider possible significant rifamycin-associated drug interactions including, but not limited to, hormonal contraceptives, antiretrovirals, methadone, oral hypoglycemics, and anticoagulants. Women who use any form of hormonal birth control should be advised to also use a barrier method.
  • Pyridoxine (B6) supplements are recommended for persons taking INH who are pregnant and breastfeeding women, breastfeeding infants, children and adolescents with nutritional deficiencies, persons with seizure disorder, patients who develop signs and symptoms of peripheral neuropathy while taking INH, and those with medical conditions associated with peripheral neuropathy (i.e. diabetes, malnutrition, chronic renal failure/dialysis, uremia, chronic alcohol use, HIV). Give pyridoxine 10-50 mg/day. Pyridoxine (B6) supplements are not required for RIF-only regimen.
  • Educate patients and caregivers about importance of good adherence. Emphasize possible side effects and adverse reactions. Provide patients with written instructions for adverse events. Advise to stop treatment and promptly seek medical evaluation if these occur. Have clients explain what they understand back to you. Use a trained interpreter if language is a barrier.
  • For any regimen, support adherence to ensure successful completion by:
    •  Identifying possible barriers to adherence (appointment conflicts, misinformation about TB, health beliefs and practices, limited financial resources, co-existing medical conditions, medication side effects, language barriers, real or perceived stigma)
    • Collaborating with community agencies to obtain incentives and/or enablers, case management or directly observed therapy
    • Providing effective patient education and patient-focused strategies