330. Three Month Treatment for Latent Tuberculosis Infection (LTBI) with Rifapentine and INH (R&I) in a Medical Center Employee Health Service (EHS) - Strategy and Advantages
Session: Poster Abstract Session: HAI: Occupational Health
Thursday, October 8, 2015
Room: Poster Hall
Posters
  • 330_IDWPOSTER.pdf (255.9 kB)
  • Background: Two years ago at these meetings, we described our initial success with the three month weekly treatment of LTBI employee-patients with R&I. Last year, we further expounded on the tactics we employ to make this treatment regimen especially efficient and convenient without having to utilize Directly Observed Therapy (DOT).  As the number of treated patients has grown, so have our insights on the advantages and shortcomings of this technique.

    Methods: Employees identified with LTBI are all evaluated by an Infectious Disease specialist in the EHS.  When appropriate, treatment options with INH, rifampin, and R&I, as well as no treatment, are discussed and, when treatment is elected, it is offered without cost.  For those opting for R&I, monthly evaluations include LFTs and CBC.  Strategy  for this treatment group includes weekly electronic reminders, with compliance monitored by monthly urine color checks, as well as assurance that prescriptions have been filled.

    Results: Of the 53 employees who began R&I and had an opportunity to complete treatment through 5/26/15, 8 (15%) did not complete treatment, 3 due to allergic symptoms, 1 due to abnormal LFTs, 1 due to severe flu-like symptoms, 1 who became pregnant, 1 who was not compliant, and 1 due to a misunderstanding.  Of the 45 who completed treatment, 12 had minor flu-like symptoms, 14 had slightly abnormal LFTs, and 9 had minor hematologic abnormalities. 

     Conclusion: With an 84.9% completion rate, R&I treatment completion well exceeds the completion rate with INH alone described by others.  A 3 month course of weekly R&I offers obvious advantages in time invested both by employee-patients and EHS staff.  Although flu-like symptoms are usually mild and rarely in our experience impact completion of treatment, they can occur in as many as 23% of patients and should be anticipated and addressed.  Liver and hematologic abnormalities are infrequent and typically inconsequential, but should be monitored through monthly testing.  Surrogate monitoring of employee compliance through urine color inspection and accountability for prescription filling can alleviate the burden of DOT.

    William Schneider, MD, MPH1, Cynthia Eisenstein, RN, COHN1, Susan K. Seo, MD2,3, Sherard N.J. Lacaille, MBBS4, Maria Del Castillo Garcia, MD2, Esther Arguello Perez, MD2, Fabian Andres Romero, MD2, Anabella Lucca Bianchi, MD2, Sejal M. Morjaria, MD2, Susan Murillo, PharmD5 and Arthur E. Brown, MD, FIDSA, FSHEA1,2,3, (1)Employee Health & Wellness Services, Memorial Sloan Kettering Cancer Center, New York, NY, (2)Infectious Disease Service, Memorial Sloan Kettering Cancer Center, New York, NY, (3)Department of Medicine, Weill Cornell Medical College, New York, NY, (4)Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, (5)Pharmacy Service, Memorial Sloan Kettering Cancer Center, New York, NY

    Disclosures:

    W. Schneider, None

    C. Eisenstein, None

    S. K. Seo, None

    S. N. J. Lacaille, None

    M. Del Castillo Garcia, None

    E. Arguello Perez, None

    F. A. Romero, None

    A. Lucca Bianchi, None

    S. M. Morjaria, None

    S. Murillo, None

    A. E. Brown, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.