Infectious Diseases

Answer 3 Rifampin (10 mg/kg) and pyrazinamide (15-20 mg/kg) daily for 2 months. The preferred treatment of latent TB infection (LTBI) in persons not infected with HIV is a 9-month regimen of isoniazid. Administration of rifampin for 4 months or administration of isoniazid for 6 months is also acceptable. The combination of rifampin plus pyrazinamide administered for 2 months was effective and well tolerated in HIV-infected persons treated for LTBI and was recommended as an alternative regimen in the American Thoracic Society and Centers for Disease Control and Prevention Guidelines of 2000.2 However, between February and August of 2001, a total of 21 cases of liver injury, including 5 deaths, have been reported among persons treated with this combination. The guidelines recently have been revised, and the combination of rifampin and pyrazinamide should be used with caution, especially in patients with alcoholism and those taking potentially hepatotoxic medications. The combination regimen is contraindicated in patients with liver disease.3 REFERENCES 2. American Thoracic Society, Centers for Disease Control and Prevention. Targeted tuberculin testing and treatment of latent tuberculosis infection. Am J Respir Crit Care Med 2000;161(4 Pt 2):S221-47. 3. Update: fatal and severe liver injuries associated with rifampin and pyrazinamide for latent tuberculosis infection, and revisions in American Thoracic Society/CDC recommendations - United States, 2001. MMWR Morb Mortal Wkly Rep 2001;50:733-5. Click here to return to the questions

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