Reflections on the Guidelines for the Prevention of Tuberculosis of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR)
Puntualizaciones acerca de la Normativa SEPAR sobre prevención de la tuberculosis
R. Vidal
Read
4997
Timeswas read the article
1787
Total PDF
3210
Total HTML
Share statistics
array:19 [ "pii" => "13051518" "issn" => "15792129" "estado" => "S300" "fechaPublicacion" => "2003-09-01" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Arch Bronconeumol. 2003;39:432-3" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2531 "formatos" => array:3 [ "EPUB" => 99 "HTML" => 1828 "PDF" => 604 ] ] "itemSiguiente" => array:15 [ "pii" => "13051517" "issn" => "15792129" "estado" => "S300" "fechaPublicacion" => "2003-09-01" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Arch Bronconeumol. 2003;39:432" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2467 "formatos" => array:3 [ "EPUB" => 118 "HTML" => 1798 "PDF" => 551 ] ] "en" => array:9 [ "idiomaDefecto" => true "titulo" => "Comments on the Guidelines for the Prevention of Tuberculosis of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR)" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "432" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Comentarios a la Normativa SEPAR sobre la prevención de la tuberculosis" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "JM Pina Gutiérrez, JL López Sanmartín, MR Sala Farré" "autores" => array:3 [ 0 => array:2 [ "Iniciales" => "JM" "apellidos" => "Pina Gutiérrez" ] 1 => array:2 [ "Iniciales" => "JL" "apellidos" => "López Sanmartín" ] 2 => array:2 [ "Iniciales" => "MR" "apellidos" => "Sala Farré" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/13051517?idApp=UINPBA00003Z" "url" => "/15792129/0000003900000009/v0_201307090907/13051517/v0_201307090908/en/main.assets" ] "itemAnterior" => array:15 [ "pii" => "13051516" "issn" => "15792129" "estado" => "S300" "fechaPublicacion" => "2003-09-01" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Arch Bronconeumol. 2003;39:431-2" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2878 "formatos" => array:3 [ "EPUB" => 119 "HTML" => 2057 "PDF" => 702 ] ] "en" => array:9 [ "idiomaDefecto" => true "titulo" => "Storiform-type Malignant Histiocytoma of the Lung" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "431" "paginaFinal" => "432" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Fibrohistiocitoma maligno de pulmón variedad estoriforme" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A Ríos Zambudio, MJ Roca Calvo, LA Polo García" "autores" => array:3 [ 0 => array:2 [ "Iniciales" => "A" "apellidos" => "Ríos Zambudio" ] 1 => array:2 [ "Iniciales" => "MJ" "apellidos" => "Roca Calvo" ] 2 => array:2 [ "Iniciales" => "LA" "apellidos" => "Polo García" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/13051516?idApp=UINPBA00003Z" "url" => "/15792129/0000003900000009/v0_201307090907/13051516/v0_201307090908/en/main.assets" ] "en" => array:10 [ "idiomaDefecto" => true "titulo" => "Reflections on the Guidelines for the Prevention of Tuberculosis of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR)" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "432" "paginaFinal" => "433" ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "R Vidal" "autores" => array:1 [ 0 => array:2 [ "Iniciales" => "R" "apellidos" => "Vidal" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Puntualizaciones acerca de la Normativa SEPAR sobre prevención de la tuberculosis" ] ] "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">To the editor:</span> We greatly appreciate the critical review and comments on the Guidelines for the Prevention of Tuberculosis made by Pina et al as they have led us to think over the points they consider debatable.</p><p class="elsevierStylePara">The first question they raise concerns the dosages of intermittently administered rifampicin (R) and isoniazid (H) for chemical prophylaxis or tuberculosis infection treatment. In the first place we ought to point out that these intermittent regimens are hardly ever used in Spain; in particular, R is not usually prescribed, as it would only be recommended for persons who are contacts of patients resistant to H and in the exceptional circumstances of patients who can not follow a daily regimen of 4R. We agree that the dose of R that is usually recommended is 600 mg, but in intermittent treatments failure to take a single dose or to absorb it properly would render the treatment ineffective. Treatment is more likely to be successful with a dose of 900 mg and there is only a slight increase in risk for the very infrequent "flu-like syndrome." However, we would accept replacing 900 mg with 600 to 900 mg.</p><p class="elsevierStylePara">The dose of 15 mg/kg with a maximum of 900 mg of H in intermittent chemical prophylaxis is recommended by the American Thoracic Society (ATS) both in intermittent treatment and for prevention.<span class="elsevierStyleSup">1,2</span></p><p class="elsevierStylePara">Secondly, the duration of treatment in chemical prophylaxis using H is a very controversial subject that will soon be resolved by the regular use of shorter treatment regimens using 2 drugs. Such regimens have higher adherence rates and are therefore more effective. The 1994 North American guidelines issued jointly by the ATS, the Centers for Disease Control and Prevention, and the Infectious Diseases Society of America recommended that treatment should last 6 months, as did the writers of the 1992 Spanish consensus report for the control of tuberculosis and the recommendations of the Research Unit on Tuberculosis of Barcelona.<span class="elsevierStyleSup">3</span> However, the 2000 ATS Guidelines already recommended a treatment regimen of 9 months. This change of policy is based on Comstok's<span class="elsevierStyleSup">4</span> theoretical re-evaluation of the results of 2 studies carried out in the 1960s. One of the studies dealt only with persons presenting untreated fibrotic lesions and reported the successful prevention of re-infection in 69% of patients using 6H and in 93% using 12H. The other study focused mostly on analyzing the total amount of H taken. A policy change was not endorsed by the British Thoracic Society (BTS) in its latest recommendations<span class="elsevierStyleSup">5</span> or by a recent Spanish consensus conference. We still think that a 6-month course of treatment, as is given to the source case with very similar results, is more recommendable.<span class="elsevierStyleSup">5</span> However, treatment may be extended from 6 to 9 or 12 months in individual cases when the prescribing physician thinks it appropriate, given that less than 6 months is not to be recommended and more than 12 months is not necessary.</p><p class="elsevierStylePara">In any case the 2000 ATS Guidelines on which Pina et al. have based their observations, have several disputable points. In the first place, they replace the term "chemical prophylaxis" with "latent tuberculosis infection treatment," arguing that the word treatment is more forceful and persuades the patient to be more compliant. However in many cases it could have negative repercussions on healthy contacts by leading them to believe that they are ill and need to isolate themselves. Furthermore, we think that the addition of "latent" is unnecessary. Consequently, we have continued to use both "chemical prophylaxis" and "tuberculosis infection treatment" as synonyms.</p><p class="elsevierStylePara">The SEPAR guidelines also recommend a short treatment protocol using 2 drugs: R and pyrazinamide (Z), 2 RZ, which is giving an unacceptable rate of severe hepatotoxicity unless patients are monitored very frequently<span class="elsevierStyleSup">6</span>; but the 3RH regimen advocated by the BTS<span class="elsevierStyleSup">5</span> as equally effective, better tolerated, and more easily administered is not even mentioned.</p><p class="elsevierStylePara">Finally we would like to point out that, in the future, chemical prophylaxis or tuberculosis infection treatment should be based on short courses of therapy as it is unrealistic to expect persons without symptoms to follow preventive treatments lasting 9 months or more (longer than the treatment given to people who are sick). This is particularly true given that it is unlikely that most of these people will develop tuberculosis.</p>" "pdfFichero" => "260v39n09a13051518pdf001.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "ATS." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Treatment of tuberculosis and tuberculosis infection in adults and children.Am J Respir Crit Care Med" "fecha" => "1994" "volumen" => "149" "paginaInicial" => "1359" "paginaFinal" => "74" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Targeted tuberculin testing and treatment of latent TB infection." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "ATS." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Am J RespirCrit Care Med" "fecha" => "2000" "volumen" => "161" "paginaInicial" => "S221" "paginaFinal" => "S47" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Documento de consenso sobre el estudio de contactos en los pacientes tuberculosos." "idioma" => "es" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Grupo de Estudio de Contactos de la Unidad de Investigación en Tuberculosis de Barcelona." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Med Clin (Barc)" "fecha" => "1999" "volumen" => "112" "paginaInicial" => "151" "paginaFinal" => "6" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "How much isoniazid is needed for prevention of tuberculosis among immunocompetent adults?" "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Comstock GW." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Int J Tuberc Lung Dis" "fecha" => "1999" "volumen" => "3" "paginaInicial" => "847" "paginaFinal" => "80" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10524579" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib5" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Control and prevention of tuberculosis in the United Kingdom: Code of Practice 2000." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Joint Tuberculosis Committee of the British Thoracic Society." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Thorax" "fecha" => "2000" "volumen" => "55" "paginaInicial" => "887" "paginaFinal" => "901" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11050256" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib6" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Fatal and severe liver injuries associated with rifampicin and pyrazinamide treatment for latent tuberculosis infection." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "CDC." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "MMWR" "fecha" => "2002" "volumen" => "51" "paginaInicial" => "998" "paginaFinal" => "99" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12455909" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000003900000009/v0_201307090907/13051518/v0_201307090908/en/main.assets" "Apartado" => array:4 [ "identificador" => "14576" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Letters to the editor" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000003900000009/v0_201307090907/13051518/v0_201307090908/en/260v39n09a13051518pdf001.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/13051518?idApp=UINPBA00003Z" ]
Article information
ISSN: 15792129Original language: English
The statistics are updated each day
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 3 | 3 | 6 |
| 2024 October | 32 | 18 | 50 |
| 2024 September | 43 | 12 | 55 |
| 2024 August | 45 | 33 | 78 |
| 2024 July | 29 | 16 | 45 |
| 2024 June | 24 | 17 | 41 |
| 2024 May | 35 | 18 | 53 |
| 2024 April | 28 | 26 | 54 |
| 2024 March | 28 | 28 | 56 |
| 2024 February | 41 | 42 | 83 |
| 2023 March | 5 | 3 | 8 |
| 2023 February | 26 | 19 | 45 |
| 2023 January | 21 | 35 | 56 |
| 2022 December | 30 | 36 | 66 |
| 2022 November | 30 | 24 | 54 |
| 2022 October | 23 | 34 | 57 |
| 2022 September | 18 | 21 | 39 |
| 2022 August | 33 | 35 | 68 |
| 2022 July | 23 | 47 | 70 |
| 2022 June | 19 | 19 | 38 |
| 2022 May | 27 | 27 | 54 |
| 2022 April | 24 | 27 | 51 |
| 2022 March | 24 | 38 | 62 |
| 2022 February | 25 | 70 | 95 |
| 2022 January | 30 | 38 | 68 |
| 2021 December | 21 | 30 | 51 |
| 2021 November | 41 | 44 | 85 |
| 2021 October | 76 | 38 | 114 |
| 2021 September | 44 | 31 | 75 |
| 2021 August | 56 | 26 | 82 |
| 2021 July | 31 | 21 | 52 |
| 2021 June | 32 | 29 | 61 |
| 2021 May | 39 | 26 | 65 |
| 2021 April | 64 | 71 | 135 |
| 2021 March | 39 | 19 | 58 |
| 2021 February | 25 | 20 | 45 |
| 2021 January | 17 | 12 | 29 |
| 2020 December | 14 | 10 | 24 |
| 2020 November | 19 | 11 | 30 |
| 2020 October | 18 | 10 | 28 |
| 2020 September | 17 | 11 | 28 |
| 2020 August | 22 | 10 | 32 |
| 2020 July | 16 | 18 | 34 |
| 2020 June | 24 | 6 | 30 |
| 2020 May | 26 | 16 | 42 |
| 2020 April | 30 | 17 | 47 |
| 2020 March | 37 | 18 | 55 |
| 2020 February | 23 | 13 | 36 |
| 2020 January | 20 | 10 | 30 |
| 2019 December | 20 | 24 | 44 |
| 2019 November | 22 | 16 | 38 |
| 2019 October | 20 | 16 | 36 |
| 2019 September | 17 | 24 | 41 |
| 2019 August | 23 | 17 | 40 |
| 2019 July | 21 | 10 | 31 |
| 2019 June | 21 | 8 | 29 |
| 2019 May | 18 | 11 | 29 |
| 2019 April | 50 | 19 | 69 |
| 2019 March | 37 | 17 | 54 |
| 2019 February | 17 | 13 | 30 |
| 2019 January | 18 | 4 | 22 |
| 2018 December | 19 | 15 | 34 |
| 2018 November | 38 | 10 | 48 |
| 2018 October | 38 | 20 | 58 |
| 2018 September | 23 | 14 | 37 |
| 2018 May | 7 | 0 | 7 |
| 2018 April | 19 | 8 | 27 |
| 2018 March | 17 | 4 | 21 |
| 2018 February | 30 | 3 | 33 |
| 2018 January | 30 | 8 | 38 |
| 2017 December | 24 | 5 | 29 |
| 2017 November | 30 | 2 | 32 |
| 2017 October | 23 | 8 | 31 |
| 2017 September | 28 | 6 | 34 |
| 2017 August | 43 | 9 | 52 |
| 2017 July | 33 | 5 | 38 |
| 2017 June | 41 | 8 | 49 |
| 2017 May | 35 | 4 | 39 |
| 2017 April | 31 | 5 | 36 |
| 2017 March | 22 | 3 | 25 |
| 2017 February | 15 | 2 | 17 |
| 2017 January | 12 | 4 | 16 |
| 2016 December | 30 | 4 | 34 |
| 2016 November | 37 | 9 | 46 |
| 2016 October | 51 | 13 | 64 |
| 2016 September | 56 | 8 | 64 |
| 2016 August | 42 | 10 | 52 |
| 2016 July | 26 | 5 | 31 |
| 2016 March | 2 | 0 | 2 |
| 2015 December | 2 | 0 | 2 |
| 2015 October | 22 | 3 | 25 |
| 2015 September | 24 | 4 | 28 |
| 2015 August | 18 | 12 | 30 |
| 2015 July | 20 | 9 | 29 |
| 2015 June | 21 | 4 | 25 |
| 2015 May | 25 | 9 | 34 |
| 2015 April | 18 | 7 | 25 |
| 2015 March | 25 | 8 | 33 |
| 2015 February | 19 | 4 | 23 |
| 2015 January | 17 | 4 | 21 |
| 2014 December | 20 | 6 | 26 |
| 2014 November | 19 | 5 | 24 |
| 2014 October | 29 | 11 | 40 |
| 2014 September | 19 | 7 | 26 |
| 2014 August | 17 | 6 | 23 |
| 2014 July | 16 | 8 | 24 |
| 2014 June | 24 | 7 | 31 |
| 2014 May | 31 | 8 | 39 |
| 2014 April | 28 | 6 | 34 |
| 2014 March | 29 | 7 | 36 |
| 2014 February | 30 | 7 | 37 |
| 2014 January | 20 | 9 | 29 |
| 2013 December | 22 | 9 | 31 |
| 2013 November | 14 | 6 | 20 |
| 2013 October | 23 | 8 | 31 |
| 2013 September | 26 | 7 | 33 |
| 2013 August | 24 | 9 | 33 |
| 2013 July | 38 | 8 | 46 |
| 2013 June | 30 | 7 | 37 |
| 2013 May | 22 | 3 | 25 |
| 2013 April | 10 | 3 | 13 |
| 2013 March | 5 | 2 | 7 |
Show all
