6. Chemoprophylaxis after contact with MDR-TB

Treatment of close contacts of drug-resistant active TB cases is difficult and yet is an increasingly common clinical problem. For contacts of INH-resistant index cases, INH will be ineffective, so 4RIF is recommended [47, 48].

In a prospective study, two of 41 children receiving tailored preventive therapy developed TB (confirmed and probable TB) compared to 13 of 64 children not receiving preventive treatment (OR 0.2, 95% CI 0.04–0.94) [49]. However, WHO has not recommended any form of preventive therapy for MDR contact cases. Based on the available evidence and the probability of increased likelihood to develop active TB disease following recent infection, strict clinical observation and close monitoring for the development of active TB disease for at least 2 years is preferred over the provision of preventive treatment for contacts of MDR-TB cases [1].

rifapentine (RR, 0.83 [95% CI, 0.51–1.35]) [57]. Therefore, unless the index TB case has INHresistant TB or an abbreviated regimen is required in a special situation, there is no reason not

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Identification and early chemoprophylaxis for LTBI can prevent reactivation TB and thus reduce both TB morbidity and transmission of TB in the community. In low TB-burden countries LTBI detection and IPT are important strategies for TB eradication. Diagnosis of LTBI is based on either TST or TB IGRA. The test preferred usually depends on the financial support available for public health programmes. In high TB- burden countries, LTBI detection and treatment can contribute to decreasing TB burden and transmission and also emergence of drug resistant TB. Here the guidelines are pretty straightforward and IPT should be offered to all children less than 5 years who have contact with pulmonary TB cases or HIV-positive individuals. INH is the preferred drug for LTBI and a 9-month regimen is considered optimal. However, careful clinical monitoring is required to detect drug induced liver injury early and also to ensure adherence to therapy. Clinical trials in different parts of the world have shown that this effort is worth it.

to use INH for LTBI chemoprophylaxis.

8. Conclusion

Author details

References

Rajneesh Thakur\* and Vangal Krishnaswamy Sashindran \*Address all correspondence to: rajneesh2207@gmail.com

[1] WHO. Global Tuberculosis Report 2016. Geneva: WHO; 2016

[2] Dye C, Glaziou P, Floyd K, Raviglione M. Prospects for tuberculosis elimination. Annual

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[4] Comstock GW, Livesay VT, Woolpert SF. The prognosis of a positive tuberculin reaction in childhood and adolescence. American Journal of Epidemiology. 1974;99:131-138

[5] Dye C, Scheele S, Dolin P, Pathania V, Raviglione MC. Consensus statement. Global burden of tuberculosis: Estimated incidence, prevalence, and mortality by country. WHO

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Armed Forces Medical College, Pune, India

Review of Public Health. 2013;34:271-286

Clinical management of latent tuberculosis infection should also address such concomitant risk factors as illicit-drug use, alcohol abuse, and smoking through opioid-substitution treatment and counseling about alcohol and smoking cessation, respectively. Acceptance of and adherence to the full course of latent tuberculosis treatment must be encouraged. In a study conducted in the United States and Canada, 17% of persons who were offered treatment for latent infection refused it [1]. Treatment completion varies widely (from 19 to 96%), and the reasons for non-completion need to be fully assessed [1]. The use of various incentives to promote treatment initiation and adherence, depending on the specific need of the person being treated, should be considered. Peer education, counseling, people-friendly services, and properly trained service providers boost confidence and may improve adherence to treatment [1].
