||The physician's role in tuberculosis prevention.
||CLINICS CHEST MED 1989, 10:3, 365-374.
The greatest challenge in the United States, today,
is to prevent those persons who have already acquired a TB infection
from developing the disease. Physicians play a critical role in
meeting this challenge. The natural history of TB infection is illustrated
and discussed. The least well-understood aspect of TB transmission
is that of host susceptibility. Although the precise mechanisms
underlying the reactivation of latent TB infection are not well-understood,
there are certain clinical and epidemiological factors associated
with the development of TB and these are listed along with some
general strategies for TB prevention. In this regard, air-control
measures such as urging patients to cover their noses and mouths
when coughing, the provision of adequate ventilation in buildings,
are helpful. Two approaches for providing direct protection to uninfected
persons, vaccination and drug treatment or primary prophylaxis are
discussed in detail. While isoniazid preventive therapy has been
found to substantially reduce the risk of TB at a generally acceptable
risk to the patient, for several listed reasons, this therapy is
not universally applied in the US. Alternative drugs for those resistant
to isoniazid, identification of candidates for preventive treatment,
prescribing and management of isoniazid preventive therapy are elaborated.
Consideration of the social aspects of TB and continuing the search
for new, effective, preventive therapy regimens that can be delivered
cheaply, safely and for relatively brief durations are recommended
for future TB prevention.
|KEYWORDS: GENERAL PRACTITIONER; PRIVATE SECTOR; USA.