A 62-year-old patient who consults because of close contact in recent weeks with a person with active tuberculosis. Mantoux test is positive (12 mm). His history includes treatment with oral anticoagulants (acenocoumarol) for a deep vein thrombosis a few months ago. He does not report fever or cough and is asymptomatic. Chest X-ray is normal. Which of the following treatments is the most advisable?
As of 2018, there are four dosing schedules for treatment of latent TB infection recommended by the CDC using isoniazid (INH), rifapentine (RPT) or rifampin (RIF). All treatments are effective. Health care providers should prescribe the shorter treatments, which are more convenient, whenever possible. The shortest combination would be Isoniazid + Rifapentine for three months or Rifampicin for four months. However, the fact that he is taking acenocoumarol means that the indication for this patient is Isoniazid for 9 months, since there is interaction between the rifamycin derivatives (rifapentine and rifampicin).
Isoniazid, for nine months.
Rifampicin, for four months.
Isoniazid and rifampicin, for three months.
Isoniazid and rifapentine, for three months.