Treatment of latent TB infection

Clinical description

The following group of patients are targeted for latent TB treatment using isoniazid / or 3HP Under-five children who are household contact of pulmonary TB cases 1. PLHIV A contact is a person who has a history of close and prolonged exposure to (bacteriologically confirmed and clinically diagnosed) PTB. Contacts are eligible for IPT only after active disease has been ruled out.

IPT

• For any child under 5 years of age with contact history, 6 months of IPT is indicated,

regardless of HIV status.

• For HIV-infected children, IPT is to be given lifelong (at least 36 months) for selected

high-risk settings/ population, regardless of contact history.

• A CXR is recommended, but not required, to rule out active TB in HIV-infected and

exposed children with a positive contact history.

• For all under 5 paediatrics, the recommended dosing of IPT is 10 mg/kg once daily for

6 months. Unless they are HIV-positive and living in one of the districts prioritized for life long therapy .

o Client should be given a month supply to take home.

o Client should be monitored every month to check for medication toxicity or development of active TB.

Children <1 year of age should be weighed monthly and the dose of INH adjusted for changes in weight. If a child develops signs and symptoms of active TB while on IPT, then INH should be stopped and the patient should be re-assessed and started on full TB treatment if indicated.

• All HIV-infected children and adults must receive pyridoxine (25 mg/day) for the

duration of IPT.

• IPT is intended to prevent recent TB infection from progressing to active TB disease

and to prevent LTBI from reactivation.

• Lifelong (36 months) or 6-month therapy is indicated based on TB burden in the place

of residence.

• The duration of IPT for low TB burden area will be 6 months

50 National Tuberculosis Control Programme Table 5.6-1: IPT duration and recommendations Contact history Age HIV status IPT (active TB ruled out)

Yes 0-60 months Negative 6 months Yes 0-60 months Positive 36 months / 6 months Yes >5 years Positive 36 months / 6 Months *** Lifelong therapy is given for at least 36 months **** Livelong therapy will be implemented in selected prioritized high burden districts

• 3HP(Rifapentine / Isoniazid) for 3 months: is also new therapy recommended by

WHO for treatment of latent TB infection. The dosage for weekly therapy is shown below.

Table 5.6-2 Dosage for 3HT (Rifapentine / Isoniazid)8 Drug regimen Dose per body weight Maximum dose Weekly rifapentine plus o Isoniazid: 15 mg/kg o Isoniazid = 900 mg o Rifapentine (by body weight):

isoniazid for 3 months o 10.0–14.0 kg = 300 mg o Rifapentine = 900 mg  14.1–25.0 kg = 450 mg (12 doses)

 25.1–32.0 kg = 600 mg  32.1–49.9 kg = 750 mg  ≥50.0 kg = 900 mg 8 WHO. Guidelines on the management of latent tuberculosis infection.2015. http://www.who.int/tb/publications/latent-tuberculo- sis-infection/en/ accessed April 24,2017 National Tuberculosis Control Programme 51