408. Three Month Treatment with Rifapentine and INH of Latent Tuberculosis Infection (LTBI) for Health Care Employees - Potential Advantages over Previous Strategies
Session: Poster Abstract Session: Occupational Health
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • 10749 Schneider_low.pdf (3.8 MB)
  • Background:   Evaluation of HCWs for TB is a standard procedure.  This results in the identification of varying numbers of employees with LTBI for whom treatment is beneficial, both for their own well-being and for the protection of the patients with whom they interact.  Traditionally, treatment has consisted of INH for 9 months.  (Rifampin for 4 months has been an alternative.)   A 2011 report observed that 12 week directly observed therapy (DOT) with rifapentine 900mg and INH 900 mg (R & I) given weekly was as effective as INH alone, with a higher completion rate and less hepatotoxicity.   The MSKCC Employee Health Service began offering this as a treatment option in 2013 in order to capitalize on the shorter course for operational efficiency and as a possible acceptance incentive.

    Methods:   Employees with LTBI are identified through preplacement examinations and annual screening,  evaluated by an Infectious Disease physician, and counseled on treatment, with the agents to be employed selected primarily on the basis of safety, but allowing for personal preference.  Those opting for treatment with any regimen are managed without personal cost and are seen monthly for exam and LFT’s, together with a CBC for those on R & I.  Instead of DOT, e-mail reminders are sent to each participant.

    Results:   Ten employees have been treated with R & I since January, 2013.  Four have completed their regimens and no one has discontinued treatment.   One employee developed transient flu- like symptoms.  LFTs remained normal in all patients, but one showed transient eosinophilia and another, mild leukopenia and mild thrombocytopenia. Of the ten patients, two had previously declined other treatment regimens.  In comparison with INH, this approach will have eliminated six clinic visits and lab studies for each of these actively employed individuals.

    Conclusion:   These preliminary findings suggest that using R & I for the management of LTBI may prove to be helpful in a hospital-based occupational medicine setting by reducing the time, cost, and effort of that process and, arguably, by increasing participation in treatment.  The setting and a motivated patient population permits the use of electronic reminders instead of DOT.   In our very small sample, stable liver function studies are encouraging, but a need for monitoring the hemogram is suggested.

    William J. Schneider, MD, MPH and Arthur E. Brown, MD, Memorial Sloan-Kettering Cancer Center, New York, NY

    Disclosures:

    W. J. Schneider, None

    A. E. Brown, None

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