Prednisone screening checklist

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.