| Epocrates

By vgreene, 8 May, 2018

Consider shorter tx LTBI regimens as they result in higher completion rates w/ fewer adverse events

By vgreene, 8 May, 2018

If risk for active TB low: Wait until after delivery to start tx

By vgreene, 8 May, 2018

If @ risk for progression of LTBI to dz, esp for women infected w/ HIV or who have been likely infected recently: Don’t delay tx initiation on basis of pregnancy alone, even during 1st trimester

By vgreene, 8 May, 2018

Recommend isoniazid daily or twice weekly for 9mo or 6mo

By vgreene, 8 May, 2018

Shorter treatment regimens for LTBI result in higher completion rates w/ fewer adverse events, and should be considered when selecting a regimen

By vgreene, 8 May, 2018

Choose LTBI tx regimen based on drug susceptibility results of presumed source case (if known), coexisting medical illness, and potential for drug-drug interactions:

By vgreene, 8 May, 2018

Consider shorter LTBI tx regimens as they result in higher completion rates

(BMJ)—A 51-yo man presented w/ a painful rash on his L thigh, along w/ fever, paresthesias, vomiting, and diarrhea. Exam: vital signs WNL, well-appearing; 8x8 cm violaceous, tender area on L thigh w/ vesicles; smaller lesion on R thigh. U/S showed fascial fluid planes; CT demonstrated fat stranding in subcutaneous tissues. What is the dx?

Tinea cruris

Cellulitis

Herpes zoster

Bullous pemphigoid

Necrotizing fasciitis

You are correct. Necrotizing fasciitis may be suggested by exam findings such as skip lesions, crepitus, hemorrhagic bullae, or pain out of proportion to exam. CT is the imaging test of choice and may show fluid in the fascial planes, fascial thickening, subcutaneous emphysema, and fat stranding. Prompt dx of necrotizing fasciitis may be obfuscated by early presentation or distracting findings. A high clinical suspicion is necessary. Tx is emergent surgical debridement and broad-spectrum abx. This pt was given abx and taken immediately to the OR for debridement. The U/S findings helped expedite his tx.

Emerg Med J 2017;34:686-691.

Consider shorter tx LTBI regimens as they result in higher completion rates w/ fewer adverse events

If risk for active TB low: Wait until after delivery to start tx

If @ risk for progression of LTBI to dz, esp for women infected w/ HIV or who have been likely infected recently: Don’t delay tx initiation on basis of pregnancy alone, even during 1st trimester

Recommend isoniazid daily or twice weekly for 9mo or 6mo

Recommended regimens:

Shorter treatment regimens for LTBI result in higher completion rates w/ fewer adverse events, and should be considered when selecting a regimen

Recommended regimens:

Choose LTBI tx regimen based on drug susceptibility results of presumed source case (if known), coexisting medical illness, and potential for drug-drug interactions:

Consider shorter LTBI tx regimens as they result in higher completion rates

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