2023 年的潜伏肺结核治疗方案:新奥尔良 Wetmore 结核病诊所

Amy Wolfe , Priyanka Jadhav , Amber May , Shandrica Seymour , Angela Blanchard , Juzar Ali
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引用次数: 0

摘要

USPSTF 更新了 2023 年潜伏肺结核感染(LTBI)筛查和治疗建议;介绍了每种治疗方案的疗程、副作用和益处。总体而言,含利福平的缩短治疗方案是治疗 LTBI 的首选方式。2023 年的一项最新研究评估了异烟肼(INH)+利福喷丁(RPT)或 "3HP "疗法的依从性和耐受性,并确定了可能较高风险无法完成该疗法的患者群体。它强调了在治疗初期进行有针对性教育的必要性,以避免过早中断治疗。我们在新奥尔良的经验表明,3HP 的耐受性良好,完成率高于其他 LTBI 治疗方案。利用回顾性病历审查模式,我们审查了从 2021 年 1 月 1 日至 2022 年 12 月 12 日的两年时间里接受治疗的 756 名 LTBI 患者。三种可能的治疗方案包括单用异烟肼 (INH)、单用利福平 (RIF) 或 INH + RPT (3HP)。在这些治疗方案中,3HP 组的完成率最高,尽管有文献表明这种治疗方案难以耐受。我们的经验表明,如果能很好地与临床医生讨论减轻副作用的问题,这可能仍然是一种有效且耐受性良好的治疗方案。需要更多数据来确定导致每种治疗方案成功或失败的因素。我们诊所确实有更多的护理人员和医务人员来讨论副作用并回答问题,这可能是我们成功率相对较高的原因。此外,我们将综述建议应用于我们的患者群体,并建议将糖尿病、酗酒和吸烟作为LTBI筛查和治疗受益患者的风险因素。
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Latent TB treatment regimens in 2023: Wetmore TB clinic in New Orleans

The USPSTF has updated Latent TB Infection (LTBI) screening and treatment recommendations in 2023; describing treatment courses, side effects and benefits associated with each regimen. Overall, rifampin-containing shortened regimens are the preferred modality for LTBI treatment. A recent study in 2023 evaluated adherence and tolerance of the isoniazid(INH) + rifapentine(RPT), or “3HP” regimen and identified patient groups that may be at higher risk for non-completion of this regimen. It emphasized the need for targeted education at the beginning of treatment, to avoid early discontinuation. Our experience in New Orleans demonstrated that the 3HP is well-tolerated, with higher completion rates than other LTBI regimens. Utilizing a retrospective chart review model, we reviewed 756 patients who were treated for LTBI over a two-year period from 1/2021––12/2022. The three possible treatment regimens included isoniazid (INH) alone, rifampin (RIF) alone, or INH + RPT (3HP). Of these regimens, the highest completion rate was in the 3HP group, despite literature suggesting this regimen is difficult to tolerate. Our experience suggests that this may still be an efficacious regimen that is well-tolerated if there is good access to clinicians to discuss mitigating side effects. More data is needed to determine factors that led to the success or failure for each regimen. Our clinic does have increased availability of nursing and medical staff to discuss side effects and answer questions, which may have contributed to our relatively higher success rate. In addition, we applied the review recommendations to our patient population, and would recommend the consideration of diabetes, heavy alcohol use, and tobacco use as risk factors for patients that would benefit from LTBI screening and treatment.

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来源期刊
Journal of Clinical Tuberculosis and Other Mycobacterial Diseases
Journal of Clinical Tuberculosis and Other Mycobacterial Diseases Medicine-Pulmonary and Respiratory Medicine
CiteScore
4.00
自引率
5.00%
发文量
44
审稿时长
30 weeks
期刊介绍: Journal of Clinical Tuberculosis and Mycobacterial Diseases aims to provide a forum for clinically relevant articles on all aspects of tuberculosis and other mycobacterial infections, including (but not limited to) epidemiology, clinical investigation, transmission, diagnosis, treatment, drug-resistance and public policy, and encourages the submission of clinical studies, thematic reviews and case reports. Journal of Clinical Tuberculosis and Mycobacterial Diseases is an Open Access publication.
期刊最新文献
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