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Preventive Therapy for Multidrug-Resistant Tuberculosis-Reply FREE

Margarita E. Villarino, MD, MPH; Patricia M. Simone, MD; Eugene McCray, MD; Alan B. Bloch, MD; Kenneth G. Castro, MD
JAMA. 1996;276(1):28-28. doi:10.1001/jama.1996.03540010030017
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In Reply.  —From a public health perspective, preventing the emergence and transmission of MDR TB in the community through the measures we described is more effective than trying to prevent the development of active TB in those individuals already infected. However, we acknowledge that managing patients infected with isoniazid- and rifampin-resistant strains of Mycobacterium tuberculosis, for which there is no demonstrable effective preventive therapy, is difficult and needs consideration.In answer to Dr Kirkland's questions: First, the CDC's recommendations for the management of persons exposed to MDR TB have not changed since their 1992 publication.1 We continue to strongly recommend alternative preventive therapy (ie, multidrug regimens with drugs other than isoniazid or rifampin) for contacts of MDR TB patients who have (1) a high likelihood of having been infected with the drugresistant M tuberculosis strain and (2) a high likelihood of progressing to active TB. The possibility of preventive therapy

REFERENCES

Centers for Disease Control and Prevention.  Management of persons exposed to multidrug-resistant tuberculosis . MMWR Morb Mortal wkly Rep . 1992;;41(No. (RR-II) ):61-71.
Villarino M, Geiter L, Lee S, Kendig N, Ayvazian F.  Preventive therapy for tuberculosis in the era of multidrug-resistant tuberculosis . Presented at the International Conference of the American Thoracic Society ; May 22, 1994;; Boston, Mass.
Bloch AB, Cauthen GM, Onorato IM, et al.  Nationwide survey of drug-resistant tuberculosis in the United States . JAMA . 1994;;271:665-671.
Frieden TR, Fujiwara PI, Washko RM, Hamburg MA.  Tuberculosis in New York City: turning the tide . N Engl J Med . 1995;;333:229-233.
Villarino ME, Geiter LJ, Simone PM.  The multidrug-resistant challenge to public health efforts to control tuberculosis . Public Health Rep . 1992;;107:616-625.

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Centers for Disease Control and Prevention.  Management of persons exposed to multidrug-resistant tuberculosis . MMWR Morb Mortal wkly Rep . 1992;;41(No. (RR-II) ):61-71.
Villarino M, Geiter L, Lee S, Kendig N, Ayvazian F.  Preventive therapy for tuberculosis in the era of multidrug-resistant tuberculosis . Presented at the International Conference of the American Thoracic Society ; May 22, 1994;; Boston, Mass.
Bloch AB, Cauthen GM, Onorato IM, et al.  Nationwide survey of drug-resistant tuberculosis in the United States . JAMA . 1994;;271:665-671.
Frieden TR, Fujiwara PI, Washko RM, Hamburg MA.  Tuberculosis in New York City: turning the tide . N Engl J Med . 1995;;333:229-233.
Villarino ME, Geiter LJ, Simone PM.  The multidrug-resistant challenge to public health efforts to control tuberculosis . Public Health Rep . 1992;;107:616-625.
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