MANAGEMENT OF LATENT TUBERCULOSIS INFECTION
DR.S.ABBAS ALI
MD, DFM DNB MNAMS (FAM.MED)
PGDHSc (ECHOCARDIOGRAM)
PGDHSc (ULTRASONOGRAPHY)
FCGP MCCP (CARDIOLOGY)

In general practice it is routine to see a number of latent Tuberculosis patients having symptoms like general weakness, diminished appetite, low body weight, mild fever, cough, fibrotic lesions in x-ray chest and investigations were normal except positive PPD.
Although the therapy of active pulmonary tuberculosis has improved considerably with highly effective short-course regimens, little progress has been made in the treatment of latent tuberculosis. Daily therapy with INH for 12 months has been the standard regimen for several decades. Currently, using INH daily for a 9-month course of therapy is preferred . An acceptable alternative is to use isoniazid daily for 6 months or rifampin daily for 4 months but drug induced hepatitis is a major disadvantage with this combination. Our experience shows isoniazid and ethambutol combination for 6 months is very good alternative for the treatment of latent tuberculosis. Compliance is good and side effects were also less with this combination. Before starting therapy, it should be necessary to rule out active tuberculosis. Active tuberculosis need four drugs for treatment. The dosage of INH is 300mg/day for adult and 10mg/kg body weight for children and ethambutol 15 mg/ kg body weight for children and 800mg for adults.
INDICATIONS
PPD-positive with HIV infection
PPD-negative with HIV infection in high risk group (eg., drug users)
PPD positive household contacts
PPD negative household contacts especially children
PPD positive with parenchymal scarring revealed on Chest roentgenogram
PPD positive staff of facilities in which many people could be exposed.