Treatment of latent Mycobacterium tuberculosis infection

doi:10.3877/cma.j.issn.1674-1358.2016.02.001

Abstract

Abstract:

Latent Mycobacterium tuberculosis infection is pragmatically defined as infection with M. tuberculosis, as evidenced by a positive tuberculin skin test reaction and (or) a positive interferon-γ release assay (IGRA) result without clinical manifestations of active tuberculosis. Preventive treatment for latent tuberculosis infection (LTBI) plays an important role in tuberculosis (TB) control in public and private health. Internationally, isoniazid therapy for 6-9 months, rifampicin monotherapy for 3-4 months and isoniazid plus rifampicin or rifapentine for 3-4 months have proved to be efficient. However, data about preventive treatment of LTBI in China is limited. It is of great importance for medical workers to cognize the advantages and drawbacks of different regimens in high-risk populations, and to choose efficient preventive therapy in clinical practice.

Key words: Latent tuberculosis infection, Preventive treatment

Xinhe Cheng, Sainan Bian, Yao Zhang, Xiaoqing Liu. Treatment of latent Mycobacterium tuberculosis infection[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2016, 10(02): 129-135.

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References 56

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结核发病率< 100/10万	中高收入国家	资源缺乏和中低收入国家
需要进行系统性检查和治疗	接触过肺结核患者的成人或儿童；	HIV（+）患者；
	接受TNF-α治疗的患者；	家中有肺结核患者或接触过肺结核患者的5岁以下儿童
	进行透析后经临床评估的LTBI患者；
	准备接受器官或血液移植的患者；
	矽肺患者
考虑进行系统性检查和治疗	服刑罪犯；健康工人；结核高负担国家移民；流浪者和吸毒者
无需进行系统性检查和治疗	糖尿病患者；酒精滥用者；
无需进行系统性检查和治疗	吸烟者；低体重者

结核发病率< 100/10万	中高收入国家	资源缺乏和中低收入国家
需要进行系统性检查和治疗	接触过肺结核患者的成人或儿童；	HIV（+）患者；
	接受TNF-α治疗的患者；	家中有肺结核患者或接触过肺结核患者的5岁以下儿童
	进行透析后经临床评估的LTBI患者；
	准备接受器官或血液移植的患者；
	矽肺患者
考虑进行系统性检查和治疗	服刑罪犯；健康工人；结核高负担国家移民；流浪者和吸毒者
无需进行系统性检查和治疗	糖尿病患者；酒精滥用者；
无需进行系统性检查和治疗	吸烟者；低体重者

治疗方案	单药INH	单药RIF	RIF/PZA	INH/RIF	INH/RPT
用法	（1）15 mg/kg，最大剂量为300 mg/d，1次/d；	10 mg·kg^-1·d^-1，最大剂量为600 mg、2次/周	RIF 10 mg·kg^-1·d^-1，最大剂量为600 mg、2次/周；PZA 20 mg·kg^-1·d^-1；	INH 15 mg/kg，最大剂量为300 mg/d，1次/d；RIF 10 mg·kg^-1·d^-1，最大剂量为600 mg、2次/周	INH 15 mg/kg，最大剂量为300 mg/d，1次/d；RPT 10 mg/kg
用法	（2）15 mg/kg，最大剂量为300 mg/d，2次/周	10 mg·kg^-1·d^-1，最大剂量为600 mg、2次/周	RIF 10 mg·kg^-1·d^-1，最大剂量为600 mg、2次/周；PZA 20 mg·kg^-1·d^-1；		最大剂量为900 mg/d，1次/周
疗程	6～9个月	4个月	2个月	3～4个月	3个月
疗效	90%	与6个月INH差异无统计学意义	IV阴性无随机对照，HIV阳性中等效	至少与6个月INH等效	至少与6个月INH等效
不良反应	无症状的肝酶升高；	肝毒性；	肝毒性普遍而严重	RIF与INH联合更易发生肝毒性；
	药物性肝炎；	皮肤过敏；		胃肠道反应；
	周围神经病变	高敏反应；		皮肤过敏；
		胃肠道反应		高敏反应
美国CDC（2013）	此方案疗程至少6个月，9个月疗效优于6个月，但6个月依从性更好	此方案适用不能够耐受INH或INH耐药	2003年ATS/CDC不推荐	与9个月INH等效
WHO（2015）	9个月和6个月INH可视为等效	是否等效有争议		是否等效有争议	4个月联合与9个月INH等效

治疗方案	单药INH	单药RIF	RIF/PZA	INH/RIF	INH/RPT
用法	（1）15 mg/kg，最大剂量为300 mg/d，1次/d；	10 mg·kg^-1·d^-1，最大剂量为600 mg、2次/周	RIF 10 mg·kg^-1·d^-1，最大剂量为600 mg、2次/周；PZA 20 mg·kg^-1·d^-1；	INH 15 mg/kg，最大剂量为300 mg/d，1次/d；RIF 10 mg·kg^-1·d^-1，最大剂量为600 mg、2次/周	INH 15 mg/kg，最大剂量为300 mg/d，1次/d；RPT 10 mg/kg
用法	（2）15 mg/kg，最大剂量为300 mg/d，2次/周	10 mg·kg^-1·d^-1，最大剂量为600 mg、2次/周	RIF 10 mg·kg^-1·d^-1，最大剂量为600 mg、2次/周；PZA 20 mg·kg^-1·d^-1；		最大剂量为900 mg/d，1次/周
疗程	6～9个月	4个月	2个月	3～4个月	3个月
疗效	90%	与6个月INH差异无统计学意义	IV阴性无随机对照，HIV阳性中等效	至少与6个月INH等效	至少与6个月INH等效
不良反应	无症状的肝酶升高；	肝毒性；	肝毒性普遍而严重	RIF与INH联合更易发生肝毒性；
	药物性肝炎；	皮肤过敏；		胃肠道反应；
	周围神经病变	高敏反应；		皮肤过敏；
		胃肠道反应		高敏反应
美国CDC（2013）	此方案疗程至少6个月，9个月疗效优于6个月，但6个月依从性更好	此方案适用不能够耐受INH或INH耐药	2003年ATS/CDC不推荐	与9个月INH等效
WHO（2015）	9个月和6个月INH可视为等效	是否等效有争议		是否等效有争议	4个月联合与9个月INH等效

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