       Document 0533
 DOCN  M9590533
 TI    Preventive therapy for contacts of multidrug-resistant tuberculosis. A
       Delphi survey.
 DT    9509
 AU    Passannante MR; Gallagher CT; Reichman LB; Department of Preventive
       Medicine and Community Health,; University of Medicine and Dentistry,
       New Jersey Medical School,; Newark, USA.
 SO    Chest. 1994 Aug;106(2):431-4. Unique Identifier : AIDSLINE MED/95292660
 AB    OBJECTIVE: Several outbreaks of multidrug resistant tuberculosis
       (MDR-TB) have recently occurred in which healthcare workers and others
       have become infected. Given the lack of clinical data to guide
       preventive therapy for such contacts, a Delphi survey of a panel of 31
       TB therapy experts was undertaken to identify a consensus regimen.
       DESIGN: An initial questionnaire presented three scenarios describing
       persons with significant exposure to MDR-TB and with new tuberculin skin
       test reactions > 15 mm (except one anergic patient) without evidence of
       disease. Panelists were asked to suggest possible preventive therapy
       regimens. METHODS: During a second round survey, the panel members were
       asked to review the suggested regimens provided for each scenario and to
       rank them from one to nine as extremely inappropriate to extremely
       appropriate. Results of this second survey were tabulated and shared
       with the members of the panel who were then asked to rerank each regimen
       in light of the previous cumulative panel responses. RESULTS: No
       specific regimen achieved initial positive consensus by predefined
       criteria. In two of the three scenarios the no treatment option,
       however, was deemed clearly inappropriate. The data were also analyzed
       by what percentage of respondents who ranked a regimen as at all
       appropriate (ie, six or more on the nine point scale). For scenarios
       involving a nurse, an HIV-positive tuberculin reactor, and a patient who
       was anergic HIV-positive, treatment with pyrazinamide 1,500 mg daily
       with ciprofloxacin 750 mg twice a day for 4 months received a somewhat
       appropriate rating from more than 50 percent of respondents.
       CONCLUSIONS: The management of persons exposed to and infected by
       patients with MDR-TB has become a serious problem in the context of
       MDR-TB outbreaks. This panel of experts agreed that some form of
       preventive therapy was warranted; however, they were not able to reach
       defined consensus on what regimen should be used, although a regimen of
       pyrazinamide 1,500 mg daily with ciprofloxacin 750 mg twice a day for 4
       months was considered somewhat appropriate. Clinical data on the
       efficacy of alternative preventive therapy regimens for such contacts
       are urgently needed.
 DE    Adult  Antitubercular Agents/*THERAPEUTIC USE  Ciprofloxacin/THERAPEUTIC
       USE  *Delphi Technique  Human  Middle Age  Pyrazinamide/THERAPEUTIC USE
       Support, U.S. Gov't, P.H.S.  Tuberculosis,
       Multidrug-Resistant/*PREVENTION & CONTROL  JOURNAL ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).

