Prevention and management of tuberculosis in HIV positive patients living in countries with a low prevalence of Mycobacterium tuberculosis.
We have re-examined the evidence on which current British Thoracic Society recommendations for primary and secondary prophylaxis and therapy of tuberculosis are based. We suggest that in a country such as the UK with a low prevalence of tuberculosis, primary prophylaxis should be offered primarily to tuberculin positive or anergic patients from high-incidence groups, including immigrants from high-prevalence countries, intravenous drug users and those with previous tuberculosis, that secondary prophylaxis be withheld from all but very high-risk patients and that four drug regimens which include ethambutol should be used for patients originating from, or who have lived in areas of the world with more than 2% primary isoniazid resistance.
Brook
M G
MG
Department of Medicine, Camden & Islington Community Health Services NHS Trust, London, UK.
Miller
R F
RF
D000995:Antitubercular Agents / Q000627:therapeutic use; D003428:Cross Infection / Q000517:prevention & control; D004641:Emigration and Immigration; D004977:Ethambutol / Q000627:therapeutic use; D006679:HIV Seropositivity / Q000150:complications*; D006801:Humans; D007538:Isoniazid / Q000627:therapeutic use; D010356:Patient Isolation; D015995:Prevalence; D014374:Tuberculin Test; D014376:Tuberculosis / Q000453:epidemiology / Q000517:prevention & control*; D006113:United Kingdom / Q000453:epidemiology
D000995:Antitubercular Agents; D004977:Ethambutol; D007538:Isoniazid