Management of Patient Living with Spouse with Active TB Not Yet on Treatment

Immediate Actions Required

The Centers for Disease Control and Prevention recommends that patients living with a spouse with active TB should immediately receive treatment for latent tuberculosis infection (LTBI) regardless of tuberculin skin test (TST) or interferon-gamma release assay (IGRA) results, after active TB disease has been excluded 1, 2
A chest radiograph (posterior-anterior view) should be obtained to exclude active pulmonary TB before starting LTBI treatment, as recommended by the American Thoracic Society 4
Patients should be assessed for TB symptoms, including persistent cough, weight loss, night sweats, bloody sputum, fever, or anorexia, as suggested by the Centers for Disease Control and Prevention 1, 5

The American Thoracic Society recommends 9 months of daily isoniazid (5 mg/kg, maximum 300 mg daily) as a treatment option for LTBI 1, 4, 7
The European Respiratory Society suggests 6 months of daily isoniazid as an alternative to the 9-month regimen 7, 4
The Centers for Disease Control and Prevention recommends 3-4 months of daily isoniazid plus rifampin (isoniazid 5 mg/kg max 300 mg + rifampin 10 mg/kg max 600 mg) as a treatment option for LTBI 6, 7, 4

The American Thoracic Society recommends monthly clinical monitoring for all patients to assess adherence and adverse effects 8, 4
Patients should be educated about hepatitis symptoms, including nausea, vomiting, abdominal pain, dark urine, and jaundice, as suggested by the American Thoracic Society 8, 4
Pyridoxine (vitamin B6, 25-50 mg daily) should be added to prevent peripheral neuropathy when using isoniazid, as recommended by the Centers for Disease Control and Prevention 1, 4

The patient's exposure should be reported to local public health authorities immediately, as recommended by the Centers for Disease Control and Prevention 3
Public health authorities will conduct contact investigation of the spouse's case and identify other potentially exposed individuals, as suggested by the Centers for Disease Control and Prevention 3
The spouse with active TB should be started on appropriate multidrug treatment as soon as possible to reduce ongoing transmission risk, as recommended by the European Respiratory Society and the Centers for Disease Control and Prevention 6, 5