Global policies and practices for managing persons exposed to multidrug-resistant tuberculosis.
METHODS
In the 1960s, treatment for latent tuberculosis infection (LTBI) with isoniazid proved to be so effective, safe, and inexpensive that research into alternative treatments virtually ceased. Now that multidrug-resistant tuberculosis (MDR-TB) is widespread, no data are available to guide the management of persons exposed to MDR-TB (contacts).


METHODS
We surveyed National TB Program directors and MDR-TB program managers about current practices for managing MDR-TB contacts in countries with an MDR-TB prevalence of >2% in new patients and those with programs for managing MDR-TB.


RESULTS
Of 35 countries that met the survey criteria, 25 (71%) responded; 24 of these (96%) have a guideline for managing TB contacts. Of these, 19 (76%) usually or always evaluated contacts and treated LTBI. In contrast, 10 (40%) countries reported having a guideline for managing MDR-TB contacts, 11 (44%) usually or always evaluated MDR-TB contacts, and 9 (36%) treated LTBI. Only two (8%) used a regimen that has activity against MDR-TB. Lack of evidence or guidelines was the main reason for not treating MDR-TB contacts.


CONCLUSIONS
Management of MDR-TB contacts is inconsistent and ineffective due to lack of evidence-based guidelines. There is an urgent need to generate evidence to guide policy.
Division of Tuberculosis Elimination, and Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. kcain@cdc.gov
K P
KP
Cain
L J
LJ
Nelson
J P
JP
Cegielski
D000995:Antitubercular Agents / Q000494:pharmacology / Q000627:therapeutic use*; D016358:Contact Tracing; D003625:Data Collection; D019317:Evidence-Based Medicine / Q000379:methods; D014943:Global Health; D006801:Humans; D009313:National Health Programs / Q000706:statistics & numerical data; D010865:Pilot Projects; D017410:Practice Guidelines as Topic; D018088:Tuberculosis, Multidrug-Resistant / Q000453:epidemiology / Q000517:prevention & control*
D000995:Antitubercular Agents