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Preventive Treatment for Contacts of DR-TB Patients
Learning ObjectivesPreventive Treatment for Contacts of DR-TB Patients: WHO Recommendations
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The World Health Organisation (WHO) recommends Tuberculosis Preventive Treatment (TPT) among contact persons exposed to Multidrug-resistant TB (MDR-TB) with Fluoroquinolone (FQ)-sensitive, or Isoniazid (H)-resistant with Rifampicin (R) sensitive DR-TB patients.
Points to be Considered Before TPT Initiation
- The preventive treatment should be individualized after a careful assessment of the intensity of exposure of contact with the index case.
- Confirm the source patient and their drug resistance pattern bacteriologically.
- Ascertain Latent TB Infection (LTBI) using Interferon Gamma Release Assay (IGRA) or Tuberculin Skin Tests (TST).
| TPT REGIMEN | ELIGIBLE POPULATION |
|---|---|
| 6Lfx (six-month Levofloxacin) | Among contacts exposed to patients with known MDR and FQ-sensitive TB |
| 6H (six-month Isoniazid) | Among contacts of H-susceptible TB in confirmed R-resistant TB index patient |
| 4R (four-month Rifampicin) | Among contacts with known H-resistant and R-sensitive TB |
​Regardless of whether treatment is given or not, clinical follow-up should be done for two years.
Any emergent signs and symptoms suggestive of TB should be actively investigated and curative regimens started, as needed.
Resources
- Guidelines for Programmatic Management of Drug-resistant Tuberculosis in India, March 2021.
- Consolidated Guidelines on Tuberculosis: Module 1: Prevention: Tuberculosis Preventive Treatment, 2020.
- Latent TB Infection: Updated and Consolidated Guidelines for Programmatic Management, WHO, 2018.
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