| Condition | Major Pathogens | First Choice Therapy | Alternative Therapy | Comments |
|---|---|---|---|---|
| Latent tuberculosis infection (LTBI), positive tuberculosis skin test or interferon gamma release assay without evidence for active TB disease, without known exposure to individual with drug-resistant tuberculosis | Mycobacterium tuberculosis |
Rifampin* Drug-drug interactions should be evaluated prior to starting therapy (use Lexi-Comp drug-drug interaction checker) |
Isoniazid and Rifapentine* weekly for 12 weeks is the shortest treatment option for children 2 years and older who meet criteria; refer to linked guidelines below and consider ID consultation or discussion with local public health department Patient with contraindication to Rifampin (e.g. drug-drug interaction): Isoniazid AND Pyridoxine supplementation if exclusively breastfeeding or other risk factors for peripheral neuropathy (refer to linked guidelines below) |
A short course regimen is now preferred for all eligible patients due to higher likelihood of treatment completion and lower risk for adverse effects Duration: Rifampin: 4 months Isoniazid: 9 months Refer to linked guidelines below for detailed recommendations including LTBI diagnosis and monitoring during therapy Initiation of LTBI therapy is not recommended during pregnancy unless at high risk for progression - discuss with ID or local public health department as needed |
| Latent tuberculosis infection, defined as above, with known exposure to individual with drug-resistant tuberculosis | Mycobacterium tuberculosis, drug-resistant | Consult ID and/or local public health department | Consult ID and/or local public health department | |
| Active tuberculosis disease | Mycobacterium tuberculosis | Consult ID | Consult ID |
References:
Latent Tuberculosis Infection Guidance for Preventing Tuberculosis in California. California Tuberculosis Controllers Association-California Department of Public Health Joint Guideline (June 2019 revision).
* Centers for Disease Control and Prevention. Update on Rifamycin Issues
Pediatric Empiric Antimicrobial Therapy Guidelines
This is a subsection of the UCSF Benioff Children’s Hospitals Empiric Antimicrobial Therapy Guidelines, developed by the Pediatric Antimicrobial Stewardship Programs at each campus to inform initial selection of empiric antimicrobial therapy for children at the UCSF Benioff Children’s Hospitals and affiliated outpatient sites.
These are guidelines only and not intended to replace clinical judgment. Modification of therapy may be indicated based on patient comorbidities, previous antibiotic therapy or infection history. Doses provided are usual doses but may require modification based on patient age or comorbid conditions. Refer to Pediatric Antimicrobial Dosing Guideline for further guidance on dosing in children, and Neonatal Dosing Guideline for infants < 1 month of age. Consult a pediatric pharmacist for individualized renal or hepatic dose adjustment. Durations provided are usual recommendations for patients who are responding appropriately to therapy. For additional guidance, please contact Pediatric Infectious Diseases (ID) or the Pediatric Antimicrobial Stewardship Program (ASP) at the campus where your patient is receiving care.
For questions or feedback about these guidelines, please email primary content owners, Rachel Wattier, Pediatric ASP Medical Director at BCH SF and Prachi Singh, Pediatric ASP Medical Director at BCH OAK.
The content of these guidelines was updated in July 2021. See Summary and Rationale for Changes (password login to Box needed) for detailed explanations of the content changes.