TB Treatment & Prescription Services

Treatment should be initiated after the possibility of TB disease has been excluded. Treatment regimens use isoniazid (INH) or rifampin (RIF). Of those regimens, INH for 9 months is the preferred regimen. Treatment must be modified if the patient is a contact of an individual with INH or multidrug-resistant TB.

• Treatment for Latent TB

Baseline laboratory testing (measurements of serum AST, ALT, and bilirubin) are not routinely necessary

Laboratory testing at the start of LTBI therapy is recommended for patients with any of the following factors:

• Liver disorders
• History of liver disease (e.g., hepatitis B or C, alcoholic hepatitis, or cirrhosis)
• Regular use of alcohol
• Risks for chronic liver disease
• HIV infection
• Pregnancy or the immediate postpartum period (i.e., within 3 months of delivery)

Baseline testing can be considered on an individual basis, especially for patients taking other medications for chronic medical conditions.

After baseline testing, routine periodic retesting is recommended for persons who had abnormal initial results and other persons at risk for hepatic disease.

At any time during treatment, whether or not baseline tests were done, laboratory testing is recommended for patients who have symptoms suggestive of hepatitis (e.g., fatigue, weakness, malaise, anorexia, nausea, vomiting, abdominal pain, pale stools, dark urine, chills) or who have jaundice. Patients should be instructed, at the start of treatment and at each monthly visit, to stop taking treatment and to seek medical attention immediately if symptoms of hepatitis develop and not to wait until a clinic visit to stop treatment.

AST or ALT elevations up to 5 times normal can be accepted if the patient is free of hepatitis symptoms, and up to 3 times normal if there are signs or symptoms of liver toxicity.

When requesting medication for LTBI the following items are needed:

1. Completed Patient Information Sheet for LTBI (see below for form)
2. Radiology report of chest x-ray (see below for requirements)
3. Clinician signature (if the Patient Information Sheet is not signed by the clinician, a separate prescription is required)

Fax the Patient Information Sheet, x-ray report, and prescriptions to 515-281-4570.

Chest x-ray requirements: If the patient has no risk factors for TB the chest x-ray must be dated within 6 months of the medication request. If the patient has any of the following risk factors, the chest x-ray must be within 3 months of medication requests.

• Persons who have immigrated (within the last 5 years) from areas of the world with high rates of TB
• Children less than 5 years of age who have a positive TB test
• Groups with high rates of TB transmission, such as homeless persons, injection drug users, and persons with HIV infection
• Persons who work or reside with people who are at high risk for TB in facilities or institutions such as hospitals, homeless shelters, correctional facilities, nursing homes, and residential homes for those with HIV
• Substance abuse
• Silicosis
• Diabetes mellitus
• Severe kidney disease
• Low body weight (less than 10% of Ideal)
• Head and neck cancer
• Medical treatments such as corticosteroids or organ transplant
• HIV infection (the virus that causes AIDS)
• Close contacts of a person with infectious TB disease
• Person with changes to CXR consistent with prior TB
• Organ transplants or other immunosuppressed people
• Specialized treatment (i.e. meds that depress immune system) for rheumatoid arthritis or Crohn’s disease

Recommendations for Use of an Isoniazid-Rifapentine Regimen with Direct Observation to Treat Latent Mycobacterium tuberculosis Infection

Treatment options for TB disease vary depending on many factors (HIV status, drug resistance, pregnancy, and in the treatment of children). For full recommendations see the links below.

• CDC Recommended Regimens
• MMWR for Treatment of Tuberculosis American Thoracic Society, CDC, and Infectious Diseases Society of America

Please contact the TB Control Program by phone to discuss ordering medication for the treatment of suspected/confirmed TB disease. Phone: (515) 281-8636 or (515) 281-7504.