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Latent TB Isoniazid Intolerance — SCE Infectious Diseases MCQ

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ModerateTuberculosisLatent TB Isoniazid IntoleranceSCE Infectious Diseases

A 38-year-old man on Infliximab for ankylosing spondylitis is diagnosed with latent TB (positive IGRA, normal CXR, asymptomatic). NICE recommends treatment before continuing Infliximab. He has a history of Isoniazid-induced hepatitis on a previous occasion. What is the most appropriate latent TB regimen?

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Correct answer: A — Rifampicin alone for 4 months (alternative for Isoniazid intolerance)

For patients unable to tolerate Isoniazid (e.g. previous hepatotoxicity), NICE NG33 offers Rifampicin alone for 4 months as an alternative latent TB regimen. This is well-tolerated with lower hepatotoxicity rates than Isoniazid-containing regimens. Drug interactions with Infliximab are minimal (unlike with some other biologics). Latent TB treatment should be completed (or at minimum started for 1 month) before restarting anti-TNF therapy. Close hepatic monitoring remains important with Rifampicin.

Reference: NICE NG33 2016 – TB; BSR 2024 – Anti-TNF and TB