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    Home > Active Ingredient News > Infection > Interpretation of WHO guidelines: One picture and one table teach you how to fix tuberculosis preventive treatment

    Interpretation of WHO guidelines: One picture and one table teach you how to fix tuberculosis preventive treatment

    • Last Update: 2021-06-17
    • Source: Internet
    • Author: User
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    *The professional part involved in this article is only for medical professionals to read for reference.
    One picture and one table are easy to get the wonderful preventive treatment of tuberculosis.
    First look: HIV carriers, family contacts of tuberculosis and other high-risk groups are recommended after active tuberculosis has been excluded.
    Preventive treatment of tuberculosis
    .

    Before starting preventive treatment of tuberculosis, it is necessary to exclude active tuberculosis to avoid interference with standardized tuberculosis treatment and the emergence of drug resistance
    .

    Tuberculin skin test (TST) or interferon gamma release test (IGRA) can be used to detect latent tuberculosis infection (LTBI), but neither is a reliable indicator of the progression to active tuberculosis
    .

    Isoniazid preventive treatment (IPT) is the most widely used regimen in the preventive treatment of tuberculosis, but the regimen containing rifamycin has a shorter course of treatment and has obvious advantages
    .

    LTBI is a state of sustained immune response to Mycobacterium tuberculosis antigen stimulation, and there is no obvious clinical manifestation of active tuberculosis
    .

    It is estimated that about a quarter of the world’s population is currently infected with tuberculosis[1], which is jaw-dropping! 1 in 4 people is infected with tuberculosis? Don't panic! In fact, most people do not have clinical symptoms of tuberculosis and are not infectious, but they are at risk of developing active tuberculosis
    .

    Studies have shown [2] that, on average, 5%-10% of people infected with tuberculosis will develop active tuberculosis in their lifetime, usually within the first 5 years after the initial infection
    .

    The risk of developing active tuberculosis after infection depends on several factors, the most important of which is the immune status, and preventive anti-tuberculosis treatment is required for high-risk groups
    .

    So the question is: Who needs preventive anti-tuberculosis treatment? How to choose the medication plan and course of treatment? Don't worry, the World Health Organization (WHO) has developed detailed clinical guidelines for us
    .

    Today, I will take you to interpret the relevant recommendations on preventive treatment of tuberculosis in the "Comprehensive Guidelines for Tuberculosis (2020 Edition)" [3] issued by the WHO
    .

    Recommendation 1 People who receive preventive treatment for tuberculosis first answer the first question: Which people need preventive anti-tuberculosis treatment? As mentioned above, among individuals infected with Mycobacterium tuberculosis, the average lifetime risk of developing active tuberculosis is about 5%-10%.
    This risk is significantly increased in children under 5 years of age and people with weakened immune systems.
    High
    .

    Therefore, the WHO guidelines make relevant recommendations based on high-risk factors such as age, HIV carriers, and family contacts of tuberculosis patients
    .

    1.
    1 Adults and adolescents with HIV For adults and adolescents with HIV who do not have active tuberculosis, the guidelines recommend routine preventive treatment for tuberculosis as part of the comprehensive management of AIDS
    .

    In addition, pregnant women, patients receiving antiretroviral therapy, and patients who have previously received tuberculosis treatment, regardless of the degree of immunosuppression, should receive preventive treatment for tuberculosis
    .

    1.
    2 Infants and children with HIV who have been in contact with tuberculosis patients who are less than 12 months old and found to have no active tuberculosis after clinical evaluation should receive preventive treatment for tuberculosis
    .

    For HIV carriers aged ≥12 months, if they live in an environment with a high probability of tuberculosis transmission, regardless of their contact with tuberculosis patients, they should receive tuberculosis preventive treatment as part of the comprehensive management of AIDS
    .

    In addition, the guidelines recommend that all infants and children with HIV who have successfully completed tuberculosis treatment should receive preventive tuberculosis treatment
    .

    1.
    3 Family contacts of pulmonary tuberculosis patients Children under 5 years of age who have family contacts with pulmonary tuberculosis patients are found to have no active tuberculosis after clinical evaluation.
    The guidelines recommend that preventive treatment of tuberculosis should be performed even if LTBI is not tested
    .

    Children, adolescents, and adults ≥5 years of age who have family contact with pulmonary tuberculosis patients are diagnosed with inactive tuberculosis after clinical evaluation.
    The guidelines recommend that preventive treatment for tuberculosis can be given
    .

    1.
    4 Family contacts of patients with multi-drug-resistant tuberculosis For high-risk family contacts of patients with multi-drug-resistant tuberculosis, the guidelines recommend whether to give preventive treatment for tuberculosis based on individualized risk assessment
    .

    1.
    5 Other high-risk groups For people receiving anti-tumor necrosis factor treatment, dialysis, organ or blood transplantation, and people suffering from silicosis, the guidelines recommend LTBI testing and preventive treatment for tuberculosis
    .

    For prisoners, health workers, immigrants from countries with a high burden of tuberculosis, the homeless, and drug users, the guidelines recommend LTBI testing and preventive tuberculosis treatment
    .

    For diabetics, alcoholics, smokers and underweight people, the guidelines do not recommend LTBI testing and preventive treatment of tuberculosis unless they belong to the other high-risk groups mentioned above
    .

    Recommendation 2 Exclude active tuberculosis.
    Preventive treatment of tuberculosis in patients with active tuberculosis may interfere with the standardized treatment of tuberculosis and lead to the emergence of drug resistance
    .

    Therefore, it is important to rule out active tuberculosis before starting preventive treatment for tuberculosis
    .

    Based on key decision points, namely HIV status, tuberculosis symptoms, family contact, age, LTBI test results, and abnormal chest radiographs, the WHO guidelines have developed a flow chart for preventive treatment of tuberculosis in high-risk groups (Figure 1)
    .

    2.
    1 HIV carriers For adults and adolescents with HIV who do not have symptoms such as cough, fever, weight loss or night sweats, the probability of having active tuberculosis is low
    .

    Therefore, the guidelines recommend that preventive treatment for tuberculosis should be provided regardless of the status of antiretroviral treatment
    .

    Adults and adolescents living with HIV who have symptoms such as cough, fever, weight loss, or night sweats may have active tuberculosis
    .

    Therefore, the guidelines recommend that they be evaluated for tuberculosis and other diseases, and if active tuberculosis is excluded, tuberculosis preventive treatment is provided
    .

    For infants and children with HIV who do not gain significant weight, cough, fever, or have contact with tuberculosis patients, the guidelines recommend that they be evaluated for tuberculosis and other diseases that cause these symptoms
    .

    If active tuberculosis is ruled out, preventive treatment for tuberculosis should be provided regardless of age
    .

    2.
    2 HIV-negative family contacts of tuberculosis and other risk groups For HIV-negative family contacts of tuberculosis and other risk groups ≥5 years old, if there are no tuberculosis symptoms and chest X-ray abnormalities, the guidelines recommend that active tuberculosis can be excluded
    .

    Recommendation 3 LTBI detection There is currently no gold standard for the diagnosis of LTBI.
    Two commonly used methods for detecting LTBI: tuberculin skin test (TST) and gamma interferon release test (IGRA), both of which are indirectly identified through effective immune response People with tuberculosis infection
    .

    WHO guidelines recommend that tuberculin skin test (TST) or gamma interferon release test (IGRA) can be used to detect LTBI
    .

    However, a positive test result of either method is not a reliable indicator of the risk of progression to active tuberculosis
    .

    Figure 1 Flow chart of LTBI detection and preventive treatment of tuberculosis for high-risk groups Recommended 4 Preventive treatment for tuberculosis.
    I talked about the population of preventive treatment for tuberculosis, the screening of active tuberculosis, and the detection of LTBI.
    Here are the topics that everyone cares about most.
    : The treatment plan, dosage and course of preventive anti-tuberculosis
    .

    The current preventive treatment of tuberculosis for non-drug-resistant tuberculosis strains can be roughly divided into two categories: 6-month isoniazid monotherapy (or isoniazid preventive treatment, IPT) and rifamycin (rifamycin) Ping or rifapentin) treatment plan
    .

    IPT has become the most widely used regimen in the preventive treatment of tuberculosis, but the regimen containing rifamycin has a shorter course of treatment and has obvious advantages
    .

    For the preventive treatment of multidrug-resistant tuberculosis, fluoroquinolone or other second-line drugs are required
    .

    Table 1 The recommended doses of drugs for preventive treatment of tuberculosis and above are the important recommendations for preventive treatment of tuberculosis in the 2020 WHO Comprehensive Guidelines for Tuberculosis.
    If you are interested, please read the original text.
    There are a lot of evidence-based medical evidence and more specific recommendations.

    .

    References: [1]Houben RMGJ,Dodd PJ.
    The Global Burden of Latent T uberculosis Infection:A Re-estimation Using Mathematical Modelling.
    PLOS Medicine.
    2016 Oct 25;13(10):e1002152.
    [2]Vynnycky E.
    Lifetime Risks,Incubation Period,and Serial Interval of T uberculosis.
    Am J Epidemiol.
    2000 Aug 1;152(3):247–63.
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