Interventions for Tuberculosis Control and Elimination 2002

Schools
Contacts of
new cases
Contacts of
known cases
Mental patients
- 50 0 20 40 50
Protection (%) (log scale)
Figure 53. Protection from prophylactic treatment in the prevention of acquisition
of tuberculous infection in four clinical trials conducted by the US Public Health
Service. 641
Indications and recommendations for the use
of prophylactic treatment
Prophylactic treatment is, for all practical purposes, rarely indicated. Even
if the evidence is scant, however, it makes sense to provide it to a newborn
child with a potentially infectious parent, especially the mother. This
is recommended in industrialized countries, 356 but should most likely be a
universal indication.
It is not clear what the appropriate duration of prophylactic treatment
should be. It is probably indicated, however, to continue it for perhaps up
to three months after relevant exposure has ended.
Children under the age of five years are also at high risk of acquiring
tuberculous infection from a person with sputum smear-positive tuberculosis
living in the same household and, if they become infected, are at
high risk of progression to clinically manifest tuberculosis. The IUATLD
has thus recommended systematic treatment with isoniazid of asymptomatic
children in such a situation. 8 Some of these children will not yet have
been infected (the infected being the primary target group) and will thus
receive true prophylactic treatment.
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