Prednisone screening checklist
From IDWiki
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.
