Abstract
Isoniazid chemoprophylaxis recommendations include its use in persons who have positive tuberculin reactions, but neither recent conversion nor other activation risk factors, only if they are under age 35 years. Above this threshold, the isoniazid hepatitis risk is said to outweigh the benefit of preventing activation. Because this policy is controversial, we performed a decision analysis contrasting those who take with those who decline isoniazid therapy according to three outcome measures: life expectancy, likelihood of illness (isoniazid hepatitis and active tuberculosis), and likelihood of fatal illness. We found no threshold between ages 10 and 80 years by the measures of life expectancy and likelihood of fatal illness; isoniazid benefits outweigh risks for all, though the margin is small for the elderly. A threshold exists only in the likelihood of illness: isoniazid risks outweigh benefits for those aged 50 to 65 years. Only extreme variations of assumptions affect these findings. Chemoprophylaxis recommendations should include low-risk tuberculin reactors over age 35 years.
Citations
Jun 1, 1995·American Journal of Public Health·N Adhikari, R Menzies
Jun 16, 2009·Journal of Public Health Management and Practice : JPHMP·Maria PisuLynn B Gerald
Oct 1, 2013·BMC Public Health·Alicia H ChangGulshan Bhatia
Jun 27, 2000·Australian and New Zealand Journal of Medicine·R L Stuart, M L Grayson
Jan 12, 1995·The New England Journal of Medicine·D MenziesM Fitzgerald
May 1, 1992·Chest·H L IsraelW C Maddrey
Mar 20, 2015·Internal Medicine·Shoichi MiyazawaMitsuhiko Moriyama
Jul 10, 2013·Arthritis Care & Research·Glen S HazlewoodClaire Bombardier
Apr 23, 2010·Respirology : Official Journal of the Asian Pacific Society of Respirology·Philip Lobue, Dick Menzies
Jan 1, 1988·Journal of the American Geriatrics Society·T E Finucane
Mar 1, 1997·Preventive Medicine·A M MarcusC B Schechter
Sep 1, 1995·Chest·D J SorressoS Bentley
Sep 1, 2011·History of Psychiatry·Catherine Fussinger