Prednisone screening checklist: Difference between revisions
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= Latent tuberculosis infection (LTBI) = |
== Latent tuberculosis infection (LTBI) == |
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== Indications for Screening == |
=== Indications for Screening === |
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* 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 |
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* 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. |
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== Screening Tests == |
=== Screening Tests === |
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* Tuberculin skin test (TST), OR |
* Tuberculin skin test (TST), OR |
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* Interferon gamma release assay (IGRA) |
* Interferon gamma release assay (IGRA) |
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== Treatment == |
=== Treatment === |
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* 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 |
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= Hepatitis B virus (HBV) = |
== Hepatitis B virus (HBV) == |
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== Indications for Screening == |
=== Indications for Screening === |
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* Prednisone quivalent ≥ 7.5 mg/day, with no minimum duration, OR |
* Prednisone quivalent ≥ 7.5 mg/day, with no minimum duration, OR |
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* 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 |
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== Screening Tests == |
=== Screening Tests === |
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* Serologic testing for HBsAg ± anti-HBcAb |
* Serologic testing for HBsAg ± anti-HBcAb |
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== Treatment == |
=== Treatment === |
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* Negative/negative: HBV vaccination |
* Negative/negative: HBV vaccination |
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* HBsAg-negative/anti-HBcAb-positive: refer to specialist for assessment and treatment |
* HBsAg-negative/anti-HBcAb-positive: refer to specialist for assessment and treatment |
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= Strongyloidiasis = |
== Strongyloidiasis == |
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== Indications for Screening == |
=== Indications for Screening === |
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* Any immunosuppression, AND |
* Any immunosuppression, AND |
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* Lived in or traveled to endemic region at any time |
* Lived in or traveled to endemic region at any time |
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== Screening Tests == |
=== Screening Tests === |
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* Serology, AND/OR |
* Serology, AND/OR |
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* Stool examination on three occasions for larvae |
* Stool examination on three occasions for larvae |
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== Treatment == |
=== Treatment === |
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* Ivermectin 200 mcg/kg daily for two days |
* Ivermectin 200 mcg/kg daily for two days |
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= ''Pneumocystis jirovecii'' pneumonia = |
== ''Pneumocystis jirovecii'' pneumonia == |
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== Indications for Prophylaxis == |
=== Indications for Prophylaxis === |
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* Prednisone equivalent ≥20 mg/day for ≥4-8 weeks |
* Prednisone equivalent ≥20 mg/day for ≥4-8 weeks |
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== Prophylaxis == |
=== Prophylaxis === |
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* TMP-SMX 1 SS or DS tablet daily, OR |
* TMP-SMX 1 SS or DS tablet daily, OR |
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* TMP-SMX 1 DS tablet 3 times per week |
* TMP-SMX 1 DS tablet 3 times per week |
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= Further Reading = |
== Further Reading == |
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* 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. |
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Revision as of 15:25, 17 August 2019
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.
