Preventive therapy for the patient with both universal indication and contraindication for isoniazid.
BACKGROUND
The delphi method of decision making was used to address an unusual clinical case in which various aspects of the case required opposing management strategies.


METHODS
A panel of 30 pulmonary experts was surveyed repeatedly until a convergence of treatment approaches was reached for a patient who was considered to have both a universal indication for and a universal contraindication against prevention therapy. Participants were asked to evaluate the appropriateness of proposed treatments on a scale from 1 to 9, with 1 being extremely inappropriate, 5 being equivocal, and 9 being extremely appropriate. The delphi survey data responses were compared using measures of central tendency (ie, the mean and median) and measures of variability (ie, the standard deviation and interquartile range).


RESULTS
Although no treatment was wholeheartedly supported by the experts, analysis of the three-round delphi survey responses resulted in two possible treatments: rifampin, 600 mg daily, for four months, or no treatment with close observation. Interestingly, the experts working in a non-university setting favored the rifampin treatment, and those working in a university setting favored no treatment with close observation.


CONCLUSIONS
The delphi method has the potential to be used for clinical decision making.
Passannante
M R
MR
Department of Preventive Medicine, University of Medicine and Dentistry-New Jersey Medical School, Newark 07103.
Restifo
R A
RA
Reichman
L B
LB
D000328:Adult; D000075202:Contraindications; D003697:Delphi Technique; D004359:Drug Therapy, Combination; D004977:Ethambutol / Q000008:administration & dosage; D005260:Female; D006501:Hepatic Encephalopathy / Q000139:chemically induced / Q000601:surgery; D006801:Humans; D007538:Isoniazid / Q000008:administration & dosage* / Q000009:adverse effects; D016031:Liver Transplantation; D012293:Rifampin / Q000008:administration & dosage; D013997:Time Factors; D014397:Tuberculosis, Pulmonary / Q000517:prevention & control
D004977:Ethambutol; D007538:Isoniazid; D012293:Rifampin