Prednisone screening checklist: Difference between revisions
From IDWiki
(Imported from text file) |
m (Text replacement - "Category:Immunocompromised patients" to "Category:Immunocompromised hosts") |
||
| (5 intermediate revisions by the same user not shown) | |||
| Line 1: | Line 1: | ||
| ⚫ | |||
= Prednisone screening checklist = |
|||
| ⚫ | |||
== Checklist == |
|||
| ⚫ | |||
| ⚫ | |||
* Prednisone equivalent ≥15 mg/day for >1 month AND ≥1 risk factor for LTBI |
* Prednisone equivalent ≥15 mg/day for >1 month AND ≥1 risk factor for LTBI |
||
* Risk factors for LTBI include: Close contacts of a person with active TB within the last 2 years; persons who have immigrated from countries with a high prevalence of TB; persons who work or reside in institutions with a high prevalence of TB such as homeless shelters, correctional facilities, and hospitals; and groups with high rates of TB transmission, such as homeless persons and injection drug users. |
* Risk factors for LTBI include: Close contacts of a person with active TB within the last 2 years; persons who have immigrated from countries with a high prevalence of TB; persons who work or reside in institutions with a high prevalence of TB such as homeless shelters, correctional facilities, and hospitals; and groups with high rates of TB transmission, such as homeless persons and injection drug users. |
||
=== Screening Tests === |
|||
* Tuberculin skin test (TST), OR |
* Tuberculin skin test (TST), OR |
||
* Interferon gamma release assay (IGRA) |
* Interferon gamma release assay (IGRA) |
||
=== Treatment === |
|||
* Isoniazid 5 mg/kg/day (max 300 mg/day) with pyridoxine 25-50 mg/day for 9 months |
* Isoniazid 5 mg/kg/day (max 300 mg/day) with pyridoxine 25-50 mg/day for 9 months |
||
== Hepatitis B virus (HBV) == |
|||
=== Indications for Screening === |
|||
* Prednisone quivalent ≥ 7.5 mg/day, with no minimum duration, OR |
* Prednisone quivalent ≥ 7.5 mg/day, with no minimum duration, OR |
||
* Prednisone equivalent < 7.5 mg/day in combination with another immunosuppressive medication, with no minimum duration |
* Prednisone equivalent < 7.5 mg/day in combination with another immunosuppressive medication, with no minimum duration |
||
=== Screening Tests === |
|||
* Serologic testing for HBsAg ± anti-HBcAb |
* Serologic testing for HBsAg ± anti-HBcAb |
||
=== Treatment === |
|||
* Negative/negative: HBV vaccination |
* Negative/negative: HBV vaccination |
||
| Line 36: | Line 32: | ||
* HBsAg-negative/anti-HBcAb-positive: refer to specialist for assessment and treatment |
* HBsAg-negative/anti-HBcAb-positive: refer to specialist for assessment and treatment |
||
== Strongyloidiasis == |
|||
=== Indications for Screening === |
|||
* Any immunosuppression, AND |
* Any immunosuppression, AND |
||
* Lived in or traveled to endemic region at any time |
* Lived in or traveled to endemic region at any time |
||
=== Screening Tests === |
|||
* Serology, AND/OR |
* Serology, AND/OR |
||
* Stool examination on three occasions for larvae |
* Stool examination on three occasions for larvae |
||
=== Treatment === |
|||
* Ivermectin 200 mcg/kg daily for two days |
* Ivermectin 200 mcg/kg daily for two days |
||
== ''Pneumocystis jirovecii'' pneumonia == |
|||
=== Indications for Prophylaxis === |
|||
* Prednisone equivalent ≥20 mg/day for ≥4-8 weeks |
* Prednisone equivalent ≥20 mg/day for ≥4-8 weeks |
||
=== Prophylaxis === |
|||
* TMP-SMX 1 SS or DS tablet daily, OR |
* TMP-SMX 1 SS or DS tablet daily, OR |
||
| Line 66: | Line 62: | ||
* Shafran DM, Bunce PE, and Gold WL. [https://doi.org/10.1503/cmaj.131430 Reducing the risk of infection in a 74-year-old man who is to receive prednisone]. ''CMAJ''. 2014. |
* Shafran DM, Bunce PE, and Gold WL. [https://doi.org/10.1503/cmaj.131430 Reducing the risk of infection in a 74-year-old man who is to receive prednisone]. ''CMAJ''. 2014. |
||
[[Category:Immunocompromised hosts]] |
|||
Latest revision as of 02:36, 28 February 2020
Latent tuberculosis infection (LTBI)
Indications for Screening
- Prednisone equivalent ≥15 mg/day for >1 month AND ≥1 risk factor for LTBI
- Risk factors for LTBI include: Close contacts of a person with active TB within the last 2 years; persons who have immigrated from countries with a high prevalence of TB; persons who work or reside in institutions with a high prevalence of TB such as homeless shelters, correctional facilities, and hospitals; and groups with high rates of TB transmission, such as homeless persons and injection drug users.
Screening Tests
- Tuberculin skin test (TST), OR
- Interferon gamma release assay (IGRA)
Treatment
- Isoniazid 5 mg/kg/day (max 300 mg/day) with pyridoxine 25-50 mg/day for 9 months
Hepatitis B virus (HBV)
Indications for Screening
- Prednisone quivalent ≥ 7.5 mg/day, with no minimum duration, OR
- Prednisone equivalent < 7.5 mg/day in combination with another immunosuppressive medication, with no minimum duration
Screening Tests
- Serologic testing for HBsAg ± anti-HBcAb
Treatment
- Negative/negative: HBV vaccination
- HBsAg-positive: refer to specialist for assessment and treatment
- HBsAg-negative/anti-HBcAb-positive: refer to specialist for assessment and treatment
Strongyloidiasis
Indications for Screening
- Any immunosuppression, AND
- Lived in or traveled to endemic region at any time
Screening Tests
- Serology, AND/OR
- Stool examination on three occasions for larvae
Treatment
- Ivermectin 200 mcg/kg daily for two days
Pneumocystis jirovecii pneumonia
Indications for Prophylaxis
- Prednisone equivalent ≥20 mg/day for ≥4-8 weeks
Prophylaxis
- TMP-SMX 1 SS or DS tablet daily, OR
- TMP-SMX 1 DS tablet 3 times per week
Further Reading
- Shafran DM, Bunce PE, and Gold WL. Reducing the risk of infection in a 74-year-old man who is to receive prednisone. CMAJ. 2014.
