Patient management during long periods of drug treatment for LTBI becomes increasingly important. This is because drugs used to treat LTBI may produce unwanted side effects, and especially over the course of lengthy treatment. The more commonly seen adverse effects are elevated serum liver enzyme concentrations (seen in 10%-20% of individuals taking INH), clinical hepatitis, peripheral neuropathy, hepatotoxicity (0.6% of individuals taking RIF), hypersensitivity reactions (eg., fever, headache, nephritis, musculoskeletal pain), gastrointestinal symptoms, and discoloration of urine (and other body fluids).
Recommended patient management regimen
Laboratory testing is recommended for patients with liver disorders, history of liver disease (Hepatitis B or C, etc.), users of alcohol or injection drugs, those with HIV infection, and pregnant women. In general:
- Baseline blood chemistry lab tests (eg., AST, ALT, bilirubin) may be ordered by the provider.
- Routine periodic blood tests for those at risk of hepatic disease, or persons who had abnormal baseline lab results will be ordered.
- The provider will monitor the patient for signs and symptoms of active TB disease (eg., loss of appetite, night sweats, fever, fatigue, unexplained weight loss), as well as adverse reactions to medications.
- If active TB disease is suspected, the microbiology laboratory may receive acid-fast smear and culture orders on sputum specimens.
