diff --git a/app/src/main/assets/assets/ic_chart.svg b/app/src/main/assets/assets/ic_chart.svg new file mode 100644 index 0000000..af6fea6 --- /dev/null +++ b/app/src/main/assets/assets/ic_chart.svg @@ -0,0 +1,4 @@ + + + + diff --git a/app/src/main/assets/assets/main.js b/app/src/main/assets/assets/main.js index 0c499a6..4539c12 100644 --- a/app/src/main/assets/assets/main.js +++ b/app/src/main/assets/assets/main.js @@ -1,77 +1,136 @@ // function to handle tab switching for any table function activateTab(tableContainer, tabIndex) { - if (!tableContainer) return; + if (!tableContainer) return; - tableContainer.querySelectorAll('.tab-button, .tab, .tab, .tab').forEach(tab => { - tab.classList.remove('active-option', 'active-tab'); + tableContainer + .querySelectorAll(".tab-button, .tab, .tab, .tab") + .forEach((tab) => { + tab.classList.remove("active-option", "active-tab"); }); - - tableContainer.querySelectorAll('.option-content, .tab-content, .tab-content, .tab-content').forEach(content => { - content.classList.remove('active-option', 'active-tab'); + + tableContainer + .querySelectorAll( + ".option-content, .tab-content, .tab-content, .tab-content" + ) + .forEach((content) => { + content.classList.remove("active-option", "active-tab"); }); - // Add active class to selected tab and content - const selectedTab = tableContainer.querySelectorAll('.tab-button, .tab, .tab, .tab')[tabIndex]; - const selectedContent = tableContainer.querySelectorAll('.option-content, .tab-content, .tab-content, .tab-content')[tabIndex]; - - if (selectedTab) { - if (selectedTab.classList.contains('tab')) { - selectedTab.classList.add('active-tab'); - } else if (selectedTab.classList.contains('tab-button')) { - selectedTab.classList.add('active-option'); - } else if (selectedTab.classList.contains('tab')) { - selectedTab.classList.add('active-tab'); - } else if (selectedTab.classList.contains('tab')) { - selectedTab.classList.add('active-tab'); - } + // Add active class to selected tab and content + const selectedTab = tableContainer.querySelectorAll( + ".tab-button, .tab, .tab, .tab" + )[tabIndex]; + const selectedContent = tableContainer.querySelectorAll( + ".option-content, .tab-content, .tab-content, .tab-content" + )[tabIndex]; + + if (selectedTab) { + if (selectedTab.classList.contains("tab")) { + selectedTab.classList.add("active-tab"); + } else if (selectedTab.classList.contains("tab-button")) { + selectedTab.classList.add("active-option"); + } else if (selectedTab.classList.contains("tab")) { + selectedTab.classList.add("active-tab"); + } else if (selectedTab.classList.contains("tab")) { + selectedTab.classList.add("active-tab"); } - - if (selectedContent) { - if (selectedContent.classList.contains('tab-content')) { - selectedContent.classList.add('active-tab'); - } else if (selectedContent.classList.contains('option-content')) { - selectedContent.classList.add('active-option'); - } else if (selectedContent.classList.contains('tab-content')) { - selectedContent.classList.add('active-tab'); - } else if (selectedContent.classList.contains('tab-content')) { - selectedContent.classList.add('active-tab'); - } + } + + if (selectedContent) { + if (selectedContent.classList.contains("tab-content")) { + selectedContent.classList.add("active-tab"); + } else if (selectedContent.classList.contains("option-content")) { + selectedContent.classList.add("active-option"); + } else if (selectedContent.classList.contains("tab-content")) { + selectedContent.classList.add("active-tab"); + } else if (selectedContent.classList.contains("tab-content")) { + selectedContent.classList.add("active-tab"); } + } } // Function to handle tab switching with event function handleTabSwitch(event, tabIndex) { - // Get the clicked button from the event - const clickedButton = event.currentTarget; - - const tableContainer = clickedButton.closest('.uk-overflow-auto'); - if (!tableContainer) return; - - // Get all tab buttons in this container - const tabButtons = tableContainer.querySelectorAll('.tab-button, .tab, .tab, .tab'); - - // Find the index of the clicked button within its container - const clickedIndex = Array.from(tabButtons).indexOf(clickedButton); - - // Generate a unique ID for the container if it doesn't have one - if (!tableContainer.id) { - tableContainer.id = 'table-' + Math.random().toString(36).substr(2, 9); - } - - // Switch to the correct tab - activateTab(tableContainer, clickedIndex); + // Get the clicked button from the event + const clickedButton = event.currentTarget; + + const tableContainer = clickedButton.closest(".uk-overflow-auto"); + if (!tableContainer) return; + + // Get all tab buttons in this container + const tabButtons = tableContainer.querySelectorAll( + ".tab-button, .tab, .tab, .tab" + ); + + // Find the index of the clicked button within its container + const clickedIndex = Array.from(tabButtons).indexOf(clickedButton); + + // Generate a unique ID for the container if it doesn't have one + if (!tableContainer.id) { + tableContainer.id = "table-" + Math.random().toString(36).substr(2, 9); + } + + // Switch to the correct tab + activateTab(tableContainer, clickedIndex); } function switchTab(tabIndex, event) { - handleTabSwitch(event, tabIndex); + handleTabSwitch(event, tabIndex); } // For Dropdown Togglers function toggleItem(clickedTitle) { - const itemContent = clickedTitle.nextElementSibling; - - itemContent.classList.toggle('active'); + const itemContent = clickedTitle.nextElementSibling; + + itemContent.classList.toggle("active"); + + const chevronUp = clickedTitle.querySelector(".chevron-up"); + chevronUp.classList.toggle("active"); +} + +document.addEventListener("DOMContentLoaded", function () { + const tooltips = document.querySelectorAll(".info-icon"); + + document.addEventListener("click", function (event) { + if (!event.target.closest(".info-icon")) { + document.querySelectorAll(".info-icon.active").forEach((activeIcon) => { + activeIcon.classList.remove("active"); + }); + } + }); - const chevronUp = clickedTitle.querySelector('.chevron-up'); - chevronUp.classList.toggle('active'); -} \ No newline at end of file + tooltips.forEach(function (icon) { + let tooltip = icon.querySelector(".tooltip"); + if (!tooltip) { + tooltip = document.createElement("div"); + tooltip.className = "tooltip"; + tooltip.textContent = + icon.getAttribute("data-tooltip") || "Additional information"; + + // Get positioning class from data attribute + const positionClass = + icon.getAttribute("data-tooltip-position") || "tooltip-center"; + tooltip.classList.add(positionClass); + + icon.appendChild(tooltip); + } + + let isTooltipVisible = false; + + icon.addEventListener("click", function (event) { + event.stopPropagation(); + + document.querySelectorAll(".info-icon.active").forEach((activeIcon) => { + if (activeIcon !== icon) { + activeIcon.classList.remove("active"); + const otherTooltip = activeIcon.querySelector(".tooltip"); + if (otherTooltip) otherTooltip.style.display = "none"; + } + }); + + isTooltipVisible = !this.classList.contains("active"); + this.classList.toggle("active"); + tooltip.style.display = isTooltipVisible ? "block" : "none"; + }); + }); +}); diff --git a/app/src/main/assets/assets/style.css b/app/src/main/assets/assets/style.css index 9887946..2584da9 100644 --- a/app/src/main/assets/assets/style.css +++ b/app/src/main/assets/assets/style.css @@ -1,11 +1,11 @@ /* Import from the UIkit.css file */ :root { color-scheme: light dark; - --primary-color: #5182FF; - --white-color: #FFFFFF; - --yellow-color: #FFC107; - --green-color: #009C8E; - --background-color: #F7F7F7; + --primary-color: #5182ff; + --white-color: #ffffff; + --yellow-color: #ffc107; + --green-color: #009c8e; + --background-color: #f7f7f7; --background-color-secondary: var(--white-color); --body-color: #747474; --body-color-secondary: #000; @@ -20,53 +20,53 @@ --tab-box-shadow: 0px 0px 32px 0px rgba(187, 187, 187, 0.25); --transition-duration: 500ms; --list-title-color: var(--yellow-color); - --divider-color: #C6C6C8; + --divider-color: #c6c6c8; --last-updated-color: #636366; } @media screen and (prefers-color-scheme: dark) { :root { - --primary-color: #7090FD; - --white-color: #FFFFFF; - --yellow-color: #FFC107; - --green-color: #009C8E; - --background-color: #2A2A2A; + --primary-color: #7090fd; + --white-color: #ffffff; + --yellow-color: #ffc107; + --green-color: #009c8e; + --background-color: #2a2a2a; --background-color-secondary: #343434; - --body-color: #D5D5D5; - --body-color-secondary: #F9F9F9; + --body-color: #d5d5d5; + --body-color-secondary: #f9f9f9; --link-color: var(--primary-color); --table-title-color: var(--primary-color); --titles-color: var(--white-color); --inactive-tab-color: var(--background-color-secondary); - --inactive-tab-text-color: #ECECEC; + --inactive-tab-text-color: #ececec; --active-tab-color: var(--primary-color); - --active-tab-text-color: #F9F9F9; + --active-tab-text-color: #f9f9f9; --tab-radius: 5px; --tab-box-shadow: 0px 0px 32px 0px rgba(0, 0, 0, 0.2); --transition-duration: 500ms; --list-title-color: var(--yellow-color); - --divider-color: #C6C6C8; - --last-updated-color: #B9B9B9; + --divider-color: #c6c6c8; + --last-updated-color: #b9b9b9; } } /* Keyframes + Animations */ @keyframes fadeIn { - from { + from { opacity: 0; } - to { + to { opacity: 1; } } @keyframes slideInTop { - from { + from { opacity: 0; /* height: 0; */ transform: translateY(-100%); } - to { + to { opacity: 1; /* height: auto; */ transform: translateY(0); @@ -74,12 +74,12 @@ } @keyframes slideOutTop { - from { + from { opacity: 1; height: auto; transform: translateY(0); } - to { + to { opacity: 0; height: 0; transform: translateY(-20%); @@ -87,44 +87,44 @@ } @keyframes slideInLeft { - from { + from { opacity: 0; transform: translateX(-10%); } - to { + to { opacity: 1; transform: translateX(0); } } @keyframes slideOutRight { - from { + from { opacity: 1; transform: translateX(0); } - to { + to { opacity: 0; transform: translateX(-10%); } } @keyframes slideInBottom { - from { + from { opacity: 0; transform: translateY(10%); } - to { + to { opacity: 1; transform: translateY(0); } } @keyframes slideOutBottom { - from { + from { opacity: 1; transform: translateY(0); } - to { + to { opacity: 0; transform: translateY(-10%); } @@ -132,7 +132,9 @@ html { /* 1 */ - font-family: -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", Arial, "Noto Sans", sans-serif, "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Noto Color Emoji"; + font-family: -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, + "Helvetica Neue", Arial, "Noto Sans", sans-serif, "Apple Color Emoji", + "Segoe UI Emoji", "Segoe UI Symbol", "Noto Color Emoji"; font-size: 1rem; font-weight: normal; line-height: 1.5; @@ -182,7 +184,12 @@ strong { } /* Headings */ -h1, h2, h3, h4, h5, h6 { +h1, +h2, +h3, +h4, +h5, +h6 { color: var(--titles-color); } @@ -204,9 +211,9 @@ img { } .ic_title_icon { - height: 50px !important; - width: 50px !important; - object-fit: fill !important; + height: 50px !important; + width: 50px !important; + object-fit: fill !important; } .chapter-header { @@ -398,48 +405,7 @@ hr { .uk-table-small .uk-table-link > a { padding: 0.625rem 0.75rem; } -/* Responsive table - ========================================================================== */ -/* Phone landscape and smaller */ -@media (max-width: 959px) { - .uk-table-responsive, - .uk-table-responsive tbody, - .uk-table-responsive th, - .uk-table-responsive td, - .uk-table-responsive tr { - display: block; - } - .uk-table-responsive thead { - display: none; - } - .uk-table-responsive th, - .uk-table-responsive td { - width: auto !important; - max-width: none !important; - min-width: 0 !important; - overflow: visible !important; - white-space: normal !important; - } - .uk-table-responsive th:not(:first-child):not(.uk-table-link), - .uk-table-responsive td:not(:first-child):not(.uk-table-link), - .uk-table-responsive .uk-table-link:not(:first-child) > a { - padding-top: 5px !important; - } - .uk-table-responsive th:not(:last-child):not(.uk-table-link), - .uk-table-responsive td:not(:last-child):not(.uk-table-link), - .uk-table-responsive .uk-table-link:not(:last-child) > a { - padding-bottom: 5px !important; - } - .uk-table-justify.uk-table-responsive th, - .uk-table-justify.uk-table-responsive td { - padding-left: 0; - padding-right: 0; - } - .uk-tabs-container .tabs { - justify-content: center !important; /* Center tabs on small screens */ - } -} .uk-table tbody tr { transition: background-color 0.1s linear; } @@ -470,11 +436,16 @@ th.uk-text-truncate, td.uk-text-truncate { max-width: 0; } +.uk-text-wrap { + white-space: wrap; +} /* End of import from UIkit.css file */ -table, td, th { - border: 1px solid #adadad; +table, +td, +th { + border: 1px solid #adadad; } .res-width { @@ -482,103 +453,103 @@ table, td, th { } .border-left-hidden { - border-left: hidden; + border-left: hidden; } .border-right-hidden { - border-right: hidden; + border-right: hidden; } .border-left-right-hidden { - border-right: hidden; - border-left: hidden; + border-right: hidden; + border-left: hidden; } .border-bottom-left-right-hidden { - border-right: hidden; - border-bottom: hidden; - border-left: hidden; + border-right: hidden; + border-bottom: hidden; + border-left: hidden; } .reddish { - color: var(--table-title-color); + color: var(--table-title-color); } .orange { - color: var(--link-color); + color: var(--link-color); } a { - font-style: normal; - text-decoration: underline !important; - color: var(--link-color) !important; + font-style: normal; + text-decoration: underline !important; + color: var(--link-color) !important; } .uk-table th { - padding: 1rem 0.75rem; - text-align: left; - vertical-align: bottom; - font-size: 1rem; - font-weight: bold; - color: var(--table-title-color); - text-transform: none; + padding: 1rem 0.75rem; + text-align: left; + vertical-align: bottom; + font-size: 1rem; + font-weight: bold; + color: var(--table-title-color); + text-transform: none; } .uk-table td { color: var(--body-color-secondary); } - /* Tabs */ .uk-tabs-container .tabs { - display: flex; - flex-direction: row; - justify-content: center; - flex-wrap: wrap; - align-items: stretch; - align-content: start; - gap: 24px; - width: 100%; - list-style: none; - padding: 0; - margin: 0; + display: flex; + flex-direction: row; + justify-content: center; + /* justify-items: center; */ + flex-wrap: wrap; + align-items: stretch; + align-content: start; + gap: 24px; + width: 100%; + list-style: none; + padding: 0; + margin: 0; } .tab, .tab-button { - display: inline-flex; - justify-items: center; - justify-content: center; - align-items: center; - gap: 1rem; - padding: 0.75rem; - text-align: center; - vertical-align: bottom; - font-size: 0.870rem; - background-color: var(--inactive-tab-color); - color: var(--inactive-tab-text-color); - text-transform: capitalize; - cursor: pointer; - border: none; - border-radius: var(--tab-radius); - box-shadow: var(--tab-box-shadow); - min-width: 120px; - max-width: 200px; - width: auto; - height: auto; - white-space: normal; - word-wrap: break-word; - min-height: 70px; - box-sizing: border-box; + display: inline-flex; + justify-items: center; + justify-content: center; + align-items: center; + gap: 1rem; + padding: 0.75rem; + text-align: center; + vertical-align: bottom; + font-size: 0.87rem; + background-color: var(--inactive-tab-color); + color: var(--inactive-tab-text-color); + text-transform: capitalize; + cursor: pointer; + border: none; + border-radius: var(--tab-radius); + box-shadow: var(--tab-box-shadow); + min-width: 120px; + max-width: 200px; + width: auto; + height: auto; + white-space: normal; + word-wrap: break-word; + min-height: 70px; + box-sizing: border-box; } .tab.active-tab, .tab-button.active-option, .option.active-option { - background-color: var(--active-tab-color); - color: var(--active-tab-text-color); - box-shadow: var(--tab-box-shadow); + background-color: var(--active-tab-color); + color: var(--active-tab-text-color); + box-shadow: var(--tab-box-shadow); } .tab-content, @@ -601,10 +572,11 @@ a { } .highlight { - color: var(--active-tab-color); + color: var(--primary-color); } -th, td { +th, +td { vertical-align: middle !important; } @@ -613,24 +585,24 @@ td { } td ul { - padding-left: 1.25rem; - padding-top: 0.625rem; - padding-bottom: 0.625rem; + padding-left: 1.25rem; + padding-top: 0.625rem; + padding-bottom: 0.625rem; } h3.highlight { - margin-top: 1rem; - padding-top: 0; + margin-top: 1rem; + padding-top: 0; } .view-in-chapter-highlight { - color: var(--body-color-secondary); + color: var(--body-color-secondary); } .duration { - font-size: 1rem; - margin-bottom: 0; - padding-bottom: 0; + font-size: 1rem; + margin-bottom: 0; + padding-bottom: 0; } .nested-list { @@ -644,12 +616,12 @@ h3.highlight { } .uk-list { - padding-left: 1.5rem; - font-style: normal; + padding-left: 1.5rem; + font-style: normal; } .uk-list.togglers-list { - padding-left: 0; + padding-left: 0; } .uk-paragraph { @@ -663,17 +635,17 @@ h3.highlight { position: absolute; left: 0; top: -0.25rem; - height: 2rem; - width: 0.5rem; + height: 2rem; + width: 0.5rem; background-color: var(--primary-color); - border-radius: 0.25rem; + border-radius: 0.25rem; } .uk-list-title, .uk-table-title, .custom-table-title { - position: relative; - padding-left: 1.5rem; + position: relative; + padding-left: 1.5rem; } .uk-list-title::before, @@ -683,18 +655,18 @@ h3.highlight { position: absolute; left: 0; top: -0.1875rem; - height: 2rem; - width: 0.5rem; - border-radius: 0.25rem; + height: 2rem; + width: 0.5rem; + border-radius: 0.25rem; } .uk-list-title::before { - top: -0.125rem; - background-color: var(--list-title-color); + top: -0.125rem; + background-color: var(--list-title-color); } .custom-table-title::before { - background-color: var(--green-color); + background-color: var(--green-color); } /* Togglers */ @@ -712,14 +684,14 @@ h3.highlight { } .chevron-up { - transform: rotate(-180deg); - transition: transform var(--transition-duration) ease-in-out; - font-size: 1.5rem; + transform: rotate(-180deg); + transition: transform var(--transition-duration) ease-in-out; + font-size: 1.5rem; } .chevron-up.active { - transform: rotate(0); - transition: transform var(--transition-duration) ease-in-out; + transform: rotate(0); + transition: transform var(--transition-duration) ease-in-out; } .item { @@ -731,4 +703,179 @@ h3.highlight { .item.active { max-height: 5000px; transition: max-height 800ms cubic-bezier(0.4, 0, 1, 1); -} \ No newline at end of file +} + +.with-info-icon { + display: inline-flex; + align-items: center; + gap: 0.25rem; +} + +.info-icon { + display: inline-flex; + justify-content: center; + align-items: center; + font-family: serif; + font-size: 0.8rem; + background-color: var(--primary-color); + color: white; + border-radius: 50%; + cursor: pointer; + width: 16px; + height: 16px; + line-height: 16px; + margin: 0 0rem; + position: relative; + transition: all 0.2s ease; +} + +.tooltip { + visibility: hidden; + position: absolute; + background-color: var(--primary-color); + font-weight: normal; + text-align: left; + border-radius: 6px; + padding: 10px; + /* font-size: 0.9em; */ + line-height: 1.4; + bottom: 100%; + margin-bottom: 10px; + opacity: 0; + transition: opacity 0.3s, visibility 0.3s; + box-shadow: 0 2px 10px rgba(0, 0, 0, 0.2); + pointer-events: none; + white-space: normal; + word-wrap: break-word; + font-family: system-ui, -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, + Oxygen, Ubuntu, Cantarell, "Open Sans", "Helvetica Neue", sans-serif; + width: max-content; + max-width: calc(100% + 200px); + z-index: 5000 !important; +} + +/* Tooltip positioning variants */ +.tooltip-right { + left: 0px; +} + +.tooltip-center { + left: 50%; + transform: translateX(-50%); +} + +.tooltip-left { + right: 0px; + left: auto; +} + +.tooltip-bottom-center { + top: 100%; + bottom: auto; + left: auto; + transform: translateX(-50%); + margin-bottom: 0; + margin-top: 10px; +} + +.tooltip-center-center { + bottom: -500px; + left: 30%; + margin-bottom: 0; + margin-top: 10px; +} + +/* Tooltip arrow */ +/* .tooltip::after { + content: ""; + position: absolute; + top: 100%; + left: 50%; + margin-left: -5px; + border-width: 5px; + border-style: solid; + border-color: var(--primary-color) transparent transparent transparent; +} */ + +/* Show tooltip when active */ +.info-icon.active .tooltip { + visibility: visible; + opacity: 1; + overflow: scroll; +} + +/* Responsive table + ========================================================================== */ +/* Phone landscape and smaller */ +@media (max-width: 959px) { + .uk-table-responsive, + .uk-table-responsive tbody, + .uk-table-responsive th, + .uk-table-responsive td, + .uk-table-responsive tr { + display: block; + } + .uk-table-responsive thead { + display: none; + } + .uk-table-responsive th, + .uk-table-responsive td { + width: auto !important; + max-width: none !important; + min-width: 0 !important; + overflow: visible !important; + white-space: normal !important; + } + .uk-table-responsive th:not(:first-child):not(.uk-table-link), + .uk-table-responsive td:not(:first-child):not(.uk-table-link), + .uk-table-responsive .uk-table-link:not(:first-child) > a { + padding-top: 5px !important; + } + .uk-table-responsive th:not(:last-child):not(.uk-table-link), + .uk-table-responsive td:not(:last-child):not(.uk-table-link), + .uk-table-responsive .uk-table-link:not(:last-child) > a { + padding-bottom: 5px !important; + } + .uk-table-justify.uk-table-responsive th, + .uk-table-justify.uk-table-responsive td { + padding-left: 0; + padding-right: 0; + } + + .uk-tabs-container .tabs { + display: grid; + grid-template-columns: repeat(4, 1fr); + align-content: center; + width: 100%; + } + + .tab, + .tab-button { + display: inline-block; + width: 100%; + } +} + +@media (max-width: 700px) { + .uk-tabs-container .tabs { + grid-template-columns: repeat(3, 1fr); + } +} + +@media (max-width: 500px) { + .uk-tabs-container .tabs { + grid-template-columns: repeat(2, 1fr); + } +} + +/* Shift the long AAP isoniazid tooltip in the LTBI table slightly right + so its content is not clipped. Targets only this tooltip on table_5 + and does not affect other tooltips. + This was done to solve the problem on the tooltip that was causing the text to be blurred by the background. + so the possitioning of the tooltip was changed to the left and the css below was added so that the pop up doesnt get clipped by the margin + */ +#table_5_dosages_for_recommended_lbti_treatment_regimens + .info-icon[data-tooltip*="American Academy of Pediatrics recommends an isoniazid dosage of 10 - 15 mg/kg"] + .tooltip { + right: -30px; /* move popup 30px to the right */ +} diff --git a/app/src/main/assets/json/chapter.json b/app/src/main/assets/json/chapter.json index 21c3bd3..877f23f 100644 --- a/app/src/main/assets/json/chapter.json +++ b/app/src/main/assets/json/chapter.json @@ -86,7 +86,7 @@ }, { "chapterId": 18, - "chapterTitle": "Hello and welcome clinical statement", + "chapterTitle": "Hello and Welcome clinical statement", "chapterHomePosition": 0 }, { diff --git a/app/src/main/assets/json/chart.json b/app/src/main/assets/json/chart.json index db8bc8f..d7b5692 100644 --- a/app/src/main/assets/json/chart.json +++ b/app/src/main/assets/json/chart.json @@ -63,87 +63,66 @@ "chartHomePosition": 0 }, { - "id": "table_10_pediatric_dosages_rifampin_in_children_(birth_to_15_years)", + "id": "table_10_antituberculosis_antibiotics_in_adult_patients_with_renal_impairment", "subChapterTitle": "Special Clinical Situations", "subChapterId": 24, - "chartTitle": "Table 10: Pediatric dosages - rifampin in children (birth to 15 years) dose for either daily or twice weekly therapy", + "chartTitle": "Table 10: Antituberculosis Antibiotics in Adult Patients with Renal Impairment", "chartHomePosition": 0 }, { - "id": "table_11_pediatric_dosages_ethambutol_in_children_(birth_to_15_years)", + "id": "table_11_antituberculosis_medications_which_may_be_used_for_patients_who_have_contraindications_to_or_intolerance", "subChapterTitle": "Special Clinical Situations", "subChapterId": 24, - "chartTitle": "Table 11: Pediatric dosages - Ethambutol in children (birth to 15 years)\nEthambutol is available in 100mg and 400 mg tablets", + "chartTitle": "Table 11: Antituberculosis Medications for Patients who have Contraindications to or Intolerance of First Line Agents or require IV Therapy during Acute or Critical Illness", "chartHomePosition": 0 }, { - "id": "table_12_pediatric_dosages_pyrazinamide_in_children_(birth_to_15_years)", + "id": "table_12_clinical_situations_for_which_standard_therapy_cannot_be_given_or_is_not_well_tolerated", "subChapterTitle": "Special Clinical Situations", "subChapterId": 24, - "chartTitle": "Table 12: Pediatric Dosages - Pyrazinamide in children (birth to 15 years)\nPyrazinamide is available in 500 mg tablets which are scored and can be cut in ½.", + "chartTitle": "Table 12: Clinical Situations for which Standard Therapy cannot be given or is not well-tolerated or may not be effective: Potential Alternative Regimens (Dosing and/or Drugs)", "chartHomePosition": 0 }, { - "id": "table_13_antituberculosis_antibiotics_in_adult_patients_with_renal_impairment", + "id": "table_13_when_to_start_hiv_therapy", "subChapterTitle": "Special Clinical Situations", "subChapterId": 24, - "chartTitle": "Table 13: Antituberculosis antibiotics in adult patients with renal impairment", + "chartTitle": "Table 13: When to Start HIV Therapy", "chartHomePosition": 0 }, { - "id": "table_14_antituberculosis_medications_which_may_be_used_for_patients_who_have_contraindications_to_or_intolerance", + "id": "table_14_what_to_start_choice_of_tb_therapy_and_antiretroviral_therapy_(art)_when_treating_co-infected_patients", "subChapterTitle": "Special Clinical Situations", "subChapterId": 24, - "chartTitle": "Table 14: Antituberculosis medications which may be used for patients who have contraindications to or intolerance of first line agents or who require IV therapy during acute or critical illness", + "chartTitle": "Table 14: What to start: Choice of TB Therapy and Antiretroviral Therapy (ART) when treating Co-infected Patients", "chartHomePosition": 0 }, { - "id": "table_15_clinical_situations_for_which_standard_therapy_cannot_be_given_or_is_not_well_tolerated", + "id": "table_15_summary_of_recommendations_for_treatment_of_active_tb_disease_in_persons_with_hiv", "subChapterTitle": "Special Clinical Situations", "subChapterId": 24, - "chartTitle": "Table 15: Clinical Situations for which standard therapy cannot be given or is not well- tolerated or may not be effective: Potential Alternative Regimens (Dosing and/or Drugs)", + "chartTitle": "Table 15: Summary of Recommendations for Treatment of Active TB Disease in Persons with HIV", "chartHomePosition": 0 }, { - "id": "table_16_when_to_start_hiv_therapy", + "id": "table_16_guidelines_for_treatment_of_extrapulmonary_tuberculosis", "subChapterTitle": "Antiretroviral Therapy (ART) and Treatment of HIV Seropositive Patients with Active Tuberculosis Disease", "subChapterId": 28, - "chartTitle": "Table 16: HHS Panel Recommendations on treatment of Tuberculosis Disease with HIV co-infection: Timing of Antiretroviral Therapy (ART) Initiation relative to TB treatment", + "chartTitle": "Table 16: Guidelines for Treatment of Extrapulmonary Tuberculosis: Length of Therapy and Adjunctive Use of Corticosteroids\n\n", "chartHomePosition": 0 }, { - "id": "table_17_what_to_start_choice_of_tb_therapy_and_antiretroviral_therapy_(art)_when_treating_co-infected_patients", + "id": "table_17_use_of_anti-tb_medications_in_special_situations_pregnancy_tuberculosis_meningitis_and_renal_failure", "subChapterTitle": "Antiretroviral Therapy (ART) and Treatment of HIV Seropositive Patients with Active Tuberculosis Disease", "subChapterId": 28, - "chartTitle": "Table 17: What to start: Choice of TB therapy and Antiretroviral Therapy (ART) when treating co-infected patients", + "chartTitle": "Table 17: Use of Anti-TB Medications in Special Situations: Pregnancy, Tuberculosis Meningitis, and Renal Failures", "chartHomePosition": 0 }, { - "id": "table_18_dosage_adjustments_for_art_and_rifamycins_when_used_in_combination", - "subChapterTitle": "Antiretroviral Therapy (ART) and Treatment of HIV Seropositive Patients with Active Tuberculosis Disease", - "subChapterId": 28, - "chartTitle": "Table 18: Dosage Adjustments for ART and Rifamycins when used in Combination", - "chartHomePosition": 0 - }, - { - "id": "table_19_guidelines_for_treatment_of_extrapulmonary_tuberculosis", - "subChapterTitle": "Adjunctive Use of Corticosteroid Therapy (Table 19)", - "subChapterId": 31, - "chartTitle": "Table 19: Guidelines for Treatment of Extrapulmonary* Tuberculosis: Length of therapy and Adjunctive Use of Corticosteroids", - "chartHomePosition": 0 - }, - { - "id": "table_20_use_of_anti-tb_medications_in_special_situations_pregnancy_tuberculosis_meningitis_and_renal_failure", - "subChapterTitle": "Treatment of Active TB in Pregnancy", - "subChapterId": 33, - "chartTitle": "Table 20: Use of Anti-TB Medications in Special Situations: Pregnancy, Tuberculous Meningitis and Renal Failure", - "chartHomePosition": 0 - }, - { - "id": "table_21_grady_hospital_tb_isolation_policy", - "subChapterTitle": "Surveillance for Health Care Workers", - "subChapterId": 40, - "chartTitle": "Table 21: Grady Hospital TB Isolation Policy", + "id": "table_18_grady_hospital_tb_isolation_policy", + "subChapterTitle": "Adjunctive Use of Corticosteroid Therapy", + "subChapterId": 32, + "chartTitle": "Table 18: Grady Hospital TB Isolation Policy", "chartHomePosition": 0 } ] diff --git a/app/src/main/assets/pages/10_tb_infection_control_hospital_isolation_procedures.html b/app/src/main/assets/pages/10_tb_infection_control_hospital_isolation_procedures.html index 183650b..45f7c40 100644 --- a/app/src/main/assets/pages/10_tb_infection_control_hospital_isolation_procedures.html +++ b/app/src/main/assets/pages/10_tb_infection_control_hospital_isolation_procedures.html @@ -19,7 +19,7 @@
- +

X. TB Infection Control: Hospital Isolation Procedures

diff --git a/app/src/main/assets/pages/10_tb_infection_control_hospital_isolation_procedures__a__administrative_controls.html b/app/src/main/assets/pages/10_tb_infection_control_hospital_isolation_procedures__a__administrative_controls.html index f3e604b..6e23128 100644 --- a/app/src/main/assets/pages/10_tb_infection_control_hospital_isolation_procedures__a__administrative_controls.html +++ b/app/src/main/assets/pages/10_tb_infection_control_hospital_isolation_procedures__a__administrative_controls.html @@ -19,7 +19,7 @@
- +

X. TB Infection Control: Hospital Isolation Procedures

diff --git a/app/src/main/assets/pages/10_tb_infection_control_hospital_isolation_procedures__b__surveillance_for_health_care_workers.html b/app/src/main/assets/pages/10_tb_infection_control_hospital_isolation_procedures__b__surveillance_for_health_care_workers.html index cee035f..ba97caa 100644 --- a/app/src/main/assets/pages/10_tb_infection_control_hospital_isolation_procedures__b__surveillance_for_health_care_workers.html +++ b/app/src/main/assets/pages/10_tb_infection_control_hospital_isolation_procedures__b__surveillance_for_health_care_workers.html @@ -18,7 +18,7 @@
- +

X. TB Infection Control: Hospital Isolation Procedures

@@ -54,7 +54,7 @@ positive test for LTBI (regardless of age) and no evidence of active disease should be encouraged to take treatment for LTBI (see Treatment for LTBI).

-
+
diff --git a/app/src/main/assets/pages/10_tb_infection_control_hospital_isolation_procedures__d__personal_respiratory_protection.html b/app/src/main/assets/pages/10_tb_infection_control_hospital_isolation_procedures__d__personal_respiratory_protection.html index 4502abf..c084ed6 100644 --- a/app/src/main/assets/pages/10_tb_infection_control_hospital_isolation_procedures__d__personal_respiratory_protection.html +++ b/app/src/main/assets/pages/10_tb_infection_control_hospital_isolation_procedures__d__personal_respiratory_protection.html @@ -18,7 +18,7 @@
- +

X. TB Infection Control: Hospital Isolation Procedures

diff --git a/app/src/main/assets/pages/11_community_tuberculosis_control.html b/app/src/main/assets/pages/11_community_tuberculosis_control.html index 0f59b57..b1f0b0a 100644 --- a/app/src/main/assets/pages/11_community_tuberculosis_control.html +++ b/app/src/main/assets/pages/11_community_tuberculosis_control.html @@ -18,7 +18,7 @@
- +

XI. Community Tuberculosis Control

diff --git a/app/src/main/assets/pages/11_community_tuberculosis_control__a__tb_surveillance_in_georgia.html b/app/src/main/assets/pages/11_community_tuberculosis_control__a__tb_surveillance_in_georgia.html index b525b30..b3f8411 100644 --- a/app/src/main/assets/pages/11_community_tuberculosis_control__a__tb_surveillance_in_georgia.html +++ b/app/src/main/assets/pages/11_community_tuberculosis_control__a__tb_surveillance_in_georgia.html @@ -19,7 +19,7 @@
- +

XI. Community Tuberculosis Control

diff --git a/app/src/main/assets/pages/11_community_tuberculosis_control__b__how_to_report_tb_as_a_notifiable_disease.html b/app/src/main/assets/pages/11_community_tuberculosis_control__b__how_to_report_tb_as_a_notifiable_disease.html index 8692d91..7d7c36a 100644 --- a/app/src/main/assets/pages/11_community_tuberculosis_control__b__how_to_report_tb_as_a_notifiable_disease.html +++ b/app/src/main/assets/pages/11_community_tuberculosis_control__b__how_to_report_tb_as_a_notifiable_disease.html @@ -19,7 +19,7 @@
- +

XI. Community Tuberculosis Control

diff --git a/app/src/main/assets/pages/11_community_tuberculosis_control__c__tb_case_definitions_for_public_health_surveillance.html b/app/src/main/assets/pages/11_community_tuberculosis_control__c__tb_case_definitions_for_public_health_surveillance.html index 680802f..a855f17 100644 --- a/app/src/main/assets/pages/11_community_tuberculosis_control__c__tb_case_definitions_for_public_health_surveillance.html +++ b/app/src/main/assets/pages/11_community_tuberculosis_control__c__tb_case_definitions_for_public_health_surveillance.html @@ -18,7 +18,7 @@
- +

XI. Community Tuberculosis Control

@@ -27,8 +27,8 @@

GDPH utilizes the 2009 Council of State and Territorial Epidemiologists (CSTE) case definition for tuberculosis (Position Statement 09-ID-65) that can be accessed at: - https://ndc.services.cdc.gov/case-definitions/tuberculosis-2009/

+ href="https://ndc.services.cdc.gov/case-definitions/tuberculosis-2009/" class="res-width"> + https://ndc.services.cdc.gov/case-definitions/tuberculosis-2009/

Clinical Criteria⌃

A case that meets all of the following criteria:

diff --git a/app/src/main/assets/pages/11_community_tuberculosis_control__d__role_of_the_health_department.html b/app/src/main/assets/pages/11_community_tuberculosis_control__d__role_of_the_health_department.html index f9edfba..cf45a76 100644 --- a/app/src/main/assets/pages/11_community_tuberculosis_control__d__role_of_the_health_department.html +++ b/app/src/main/assets/pages/11_community_tuberculosis_control__d__role_of_the_health_department.html @@ -18,7 +18,7 @@
- +

XI. Community Tuberculosis Control

diff --git a/app/src/main/assets/pages/11_community_tuberculosis_control__e__hospital_discharge_planning_for_patients_with_suspected_or_proven_tb.html b/app/src/main/assets/pages/11_community_tuberculosis_control__e__hospital_discharge_planning_for_patients_with_suspected_or_proven_tb.html index 26ea428..6cc4beb 100644 --- a/app/src/main/assets/pages/11_community_tuberculosis_control__e__hospital_discharge_planning_for_patients_with_suspected_or_proven_tb.html +++ b/app/src/main/assets/pages/11_community_tuberculosis_control__e__hospital_discharge_planning_for_patients_with_suspected_or_proven_tb.html @@ -18,7 +18,7 @@
- +

XI. Community Tuberculosis Control

diff --git a/app/src/main/assets/pages/11_community_tuberculosis_control__f__interjurisdictional_tb_notification(ijn).html b/app/src/main/assets/pages/11_community_tuberculosis_control__f__interjurisdictional_tb_notification(ijn).html index 0912a5a..53033c3 100644 --- a/app/src/main/assets/pages/11_community_tuberculosis_control__f__interjurisdictional_tb_notification(ijn).html +++ b/app/src/main/assets/pages/11_community_tuberculosis_control__f__interjurisdictional_tb_notification(ijn).html @@ -19,7 +19,7 @@
- +

XI. Community Tuberculosis Control

diff --git a/app/src/main/assets/pages/11_community_tuberculosis_control__g__curetb_program_(internation_linkage_to_tb_care).html b/app/src/main/assets/pages/11_community_tuberculosis_control__g__curetb_program_(internation_linkage_to_tb_care).html index 9a5284f..592506a 100644 --- a/app/src/main/assets/pages/11_community_tuberculosis_control__g__curetb_program_(internation_linkage_to_tb_care).html +++ b/app/src/main/assets/pages/11_community_tuberculosis_control__g__curetb_program_(internation_linkage_to_tb_care).html @@ -18,7 +18,7 @@
- +

XI. Community Tuberculosis Control

@@ -141,9 +141,9 @@

Phone: (619) 542-4013

-

- GDPH utilizes the 2009 Council of State and Territorial Epidemiologists (CSTE) case definition for tuberculosis (Position Statement 09-ID-65) that can be accessed at: https://ndc.services.cdc.gov/case-definitions/tuberculosis-2009/ -

+

+ GDPH utilizes the 2009 Council of State and Territorial Epidemiologists (CSTE) case definition for tuberculosis (Position Statement 09-ID-65) that can be accessed at: https://ndc.services.cdc.gov/case-definitions/tuberculosis-2009/ +

Clinical case definition—A case that meets all of the following criteria:⌃ diff --git a/app/src/main/assets/pages/12_alternative_housing_program_for_homeless_tb_patients_in_georgia.html b/app/src/main/assets/pages/12_alternative_housing_program_for_homeless_tb_patients_in_georgia.html index d88afac..f6ec68b 100644 --- a/app/src/main/assets/pages/12_alternative_housing_program_for_homeless_tb_patients_in_georgia.html +++ b/app/src/main/assets/pages/12_alternative_housing_program_for_homeless_tb_patients_in_georgia.html @@ -18,7 +18,7 @@
- +

XII. Alternative Housing Program for Homeless TB Patients in Georgia

diff --git a/app/src/main/assets/pages/13_georgia_department_of_public_health_(dph)_community_guidelines_for_respiratory.html b/app/src/main/assets/pages/13_georgia_department_of_public_health_(dph)_community_guidelines_for_respiratory.html index 777e676..7b4f17b 100644 --- a/app/src/main/assets/pages/13_georgia_department_of_public_health_(dph)_community_guidelines_for_respiratory.html +++ b/app/src/main/assets/pages/13_georgia_department_of_public_health_(dph)_community_guidelines_for_respiratory.html @@ -18,7 +18,7 @@
- +

XIII. Georgia Department of Public Health (DPH) Community Guidelines for Respiratory Isolation of Patients with Active TB in the Community

diff --git a/app/src/main/assets/pages/14_references.html b/app/src/main/assets/pages/14_references.html index 3d18beb..f00da0e 100644 --- a/app/src/main/assets/pages/14_references.html +++ b/app/src/main/assets/pages/14_references.html @@ -18,7 +18,7 @@
- +

XIV. References

diff --git a/app/src/main/assets/pages/15_appendix_district_tb_coordinators_(by_district).html b/app/src/main/assets/pages/15_appendix_district_tb_coordinators_(by_district).html index d92619e..b327801 100644 --- a/app/src/main/assets/pages/15_appendix_district_tb_coordinators_(by_district).html +++ b/app/src/main/assets/pages/15_appendix_district_tb_coordinators_(by_district).html @@ -23,7 +23,7 @@

XV. Appendix: District TB Coordinators (by district)

-

Updated October 2025

+

Last Updated October 2025

diff --git a/app/src/main/assets/pages/16_abbreviations.html b/app/src/main/assets/pages/16_abbreviations.html index 6972e0c..08a1b56 100644 --- a/app/src/main/assets/pages/16_abbreviations.html +++ b/app/src/main/assets/pages/16_abbreviations.html @@ -19,7 +19,7 @@
- +

XVI. Abbreviations

diff --git a/app/src/main/assets/pages/17_acknowledgements.html b/app/src/main/assets/pages/17_acknowledgements.html index eae15c3..e2bf513 100644 --- a/app/src/main/assets/pages/17_acknowledgements.html +++ b/app/src/main/assets/pages/17_acknowledgements.html @@ -19,7 +19,7 @@
- +

XVII. Acknowledgements

@@ -30,7 +30,7 @@

- Multiple updates to print copies were subsequently made and in 2022, we transitioned to a mobile app through collaboration with the Georgia CTSA appHatchery. Many thanks to appHatchery members Santiago Arconada Alvarez, Morgan Greenleaf, Jingying Yao, Wilbur Lam, Maxwell Jr Kapezi, Naomi Nyama, Wiza Munthali, Kennedy Linzie, Hope Madziakapita, Kelvin Sande, and Mabuchi Nyirenda. In 2024 and 2025 we have updated and extensively revised the Guide app based on new scientific knowledge and user feedback. + Multiple updates to print copies were subsequently made and in 2022, we transitioned to a mobile app through collaboration with the Georgia CTSA appHatchery. The Georgia TB Reference Guide app was redesigned and extensively updated in 2025 based on user feedback and new developments in the field of TB. Many thanks to appHatchery members Santiago Arconada Alvarez, Morgan Greenleaf, Jingying Yao, Wilbur Lam, Upasana Bhattacharjee, Maxwell Jr Kapezi, Naomi Nyama, Wiza Munthali, Kennedy Linzie, Hope Madziakapita, Kelvin Sande, and Mabuchi Nyirenda.

diff --git a/app/src/main/assets/pages/18_for_more_information.html b/app/src/main/assets/pages/18_for_more_information.html new file mode 100644 index 0000000..422045d --- /dev/null +++ b/app/src/main/assets/pages/18_for_more_information.html @@ -0,0 +1,40 @@ + + + + + + + + For more information + + + + + + + +

+
Georgia Department of Public Health Tuberculosis Program Division of Health Protection
+ +

200 Piedmont Ave SE

+ +

West Tower Suite-1541F

+ +

Atlanta, GA 30334

+ +

(404) 657-2634

+ + https://dph.georgia.gov/tuberculosis-tb-prevention-and-control +
+
+

For additional information on the TB Reference Guide, please visit:

+ https://dph.georgia.gov/health-topics/tuberculosis-tb-prevention-and-control/tb-clinicians-and-healthcare-providers +
+
+ ../assets/imageimage +
+ + + diff --git a/app/src/main/assets/pages/1_epidemiology.html b/app/src/main/assets/pages/1_epidemiology.html index cda20b5..e663a0b 100644 --- a/app/src/main/assets/pages/1_epidemiology.html +++ b/app/src/main/assets/pages/1_epidemiology.html @@ -1,90 +1,180 @@ - + - - - - + + + + Epidemiology - - - - - - - - -
-
+ + + + + + + +
+
-
-
- -
-

I. Epidemiology

+
+
+
-

Last Updated October 2025

+

I. Epidemiology

+
+

Last Updated October 2025

-
-
-
- -

Worldwide, TB is an enormous global public health problem. The World Health Organization (WHO) estimates that there were 10.8 million new cases of active TB disease and more than 1.25 million deaths due to TB in 2023.

+
+
+
+

+ Worldwide, TB is an enormous global public health problem. The World + Health Organization (WHO) estimates that there were 10.8 million new + cases of active TB disease and more than 1.25 million deaths due to TB + in 2023. +

-

Tuberculosis (TB) is again the leading cause of death due to an infectious disease globally. TB had been the leading cause of death in 2019 prior to the COVID-19 pandemic. COVID-19 emerged globally as the leading cause of death due to a single infectious disease, but the number of COVID-19 related deaths have decreased, and TB re-emerged as the leading cause of death due to an infectious disease in 2023. TB remains the leading cause of death in persons with Human Immunodeficiency Virus (HIV) infection. +

+ Tuberculosis (TB) is again the leading cause of death due to an + infectious disease globally. TB had been the leading cause of death in + 2019 prior to the COVID-19 pandemic. COVID-19 emerged globally as the + leading cause of death due to a single infectious disease, but the + number of COVID-19 related deaths have decreased, and TB re-emerged as + the leading cause of death due to an infectious disease in 2023. TB + remains the leading cause of death in persons with Human + Immunodeficiency Virus (HIV) infection.

-

Approximately one-fourth of the world’s population is estimated to be infected with Mycobacterium tuberculosis (i.e., have latent TB infection [LTBI]) and therefore potentially at risk for developing active TB disease.

+

+ Approximately one-fourth of the world’s population is estimated to be + infected with Mycobacterium tuberculosis (i.e., have latent TB + infection [LTBI]) and therefore potentially at risk for developing + active TB disease. +

-

In the U.S., there was a resurgence of TB from 1985 to 1992. The number of cases increased 20% during this time period, peaking in 1992 with 26,673 cases reported. The increased case numbers were attributed to the HIV epidemic, decreased funding for public health, immigration from countries where TB is endemic, and transmission of TB in congregate settings such as hospitals, correctional institutions, and homeless shelters.

+

+ In the U.S., there was a resurgence of TB from 1985 to 1992. The + number of cases increased 20% during this time period, peaking in 1992 + with 26,673 cases reported. The increased case numbers were attributed + to the HIV epidemic, decreased funding for public health, immigration + from countries where TB is endemic, and transmission of TB in + congregate settings such as hospitals, correctional institutions, and + homeless shelters. +

- + Source: CDC -

Due to a number of public health interventions, TB cases began declining in 1992 in the U.S. Between 1992 and 2020, there was a 74% decrease in the number of cases, as TB control and prevention was strengthened nationally. The number of TB cases in the U.S. declined considerably in 2020 to 7,171, coinciding with the COVID-19 pandemic. However, TB case counts and incidence rates increased in 2021-2024. +

+ Due to a number of public health interventions, TB cases began + declining in 1992 in the U.S. Between 1992 and 2020, there was a 74% + decrease in the number of cases, as TB control and prevention was + strengthened nationally. The number of TB cases in the U.S. declined + considerably in 2020 to 7,171, coinciding with the COVID-19 pandemic. + However, TB case counts and incidence rates increased in 2021-2024.

- In 2024, 10,347 TB cases were provisionally reported by CDC in the US with a corresponding rate of 3.0 cases per 100,000 population. In 2023, the CDC reported 9,633 cases of active TB disease in the U.S. and an incidence rate of 2.9 cases per 100,000 persons. The incidence rate in 2022 was2.5 per 100,000). The TB case count in 2024 in the U.S. is the highest reported since 2013, and the incidence rate is the highest since 2016. + In 2024, 10,347 TB cases were provisionally reported by CDC in the US + with a corresponding rate of 3.0 cases per 100,000 population. In + 2023, the CDC reported 9,633 cases of active TB disease in the U.S. + and an incidence rate of 2.9 cases per 100,000 persons. The incidence + rate in 2022 was2.5 per 100,000). The TB case count in 2024 in the + U.S. is the highest reported since 2013, and the incidence rate is the + highest since 2016.

- - + + Source: CDC -

TB is not evenly distributed among the U.S. population. Recovery from pandemic-related health care disruptions, increases in post-pandemic travel and migration, and outbreaks in several states have likely contributed to recent TB trends. Cases occur disproportionately in urban areas, in conditions of poverty, undernutrition, over-crowding, and among racial and ethnic minorities and non-US-born persons. +

+ TB is not evenly distributed among the U.S. population. Recovery from + pandemic-related health care disruptions, increases in post-pandemic + travel and migration, and outbreaks in several states have likely + contributed to recent TB trends. Cases occur disproportionately in + urban areas, in conditions of poverty, undernutrition, over-crowding, + and among racial and ethnic minorities and non-US-born persons.

- In 2024, 76% of US TB cases occurred among Non-US Born persons. In 2023, 776% of the U.S. TB cases occurred among non-US born persons. + In 2024, 76% of US TB cases occurred among Non-US Born persons. In + 2023, 776% of the U.S. TB cases occurred among non-US born persons.

- + - Data on US Born and Non-US Born cases unavailable in the State of Georgia for 2024. + Data on US Born and Non-US Born cases unavailable in the State of + Georgia for 2024.

- In 2023 in the state of Georgia, 57% of TB cases occurred among non-US born persons in 2023 + In 2023 in the state of Georgia, 57% of TB cases occurred among non-US + born persons in 2023

-

The average lifetime risk of developing active TB following TB infection, if no treatment of latent TB infection (LTBI) is received, is approximately 5%. The greatest risk of progression to active TB disease is within the first two years following infection with M. tuberculosis. UNAIDS estimates that persons infected with both M. tuberculosis and HIV are 30 to 50 times more likely to develop active TB disease than those infected with M. tuberculosis but who do not have HIV infection. The risk of progression to active TB disease among people living with untreated HIV who have LTBI is up to 10% per year. +

+ The average lifetime risk of developing active TB following TB + infection, if no treatment of latent TB infection (LTBI) is received, + is approximately 5%. The greatest risk of progression to active TB + disease is within the first two years following infection with M. + tuberculosis. UNAIDS estimates that persons infected with both M. + tuberculosis and HIV are 30 to 50 times more likely to develop active + TB disease than those infected with M. tuberculosis but who do not + have HIV infection. The risk of progression to active TB disease among + people living with untreated HIV who have LTBI is up to 10% per year.

-

Drug-resistant TB is a major challenge to global TB prevention and control efforts and historically associated with a higher morbidity and mortality compared to drug-susceptible disease. Multidrug (MDR) TB is defined as resistance to at least isoniazid (INH) and rifampin (RIF). Extensively drug resistant (XDR)-TB is defined as MDR-TB plus resistance to a fluoroquinolone (FQN) drug and either bedaquiline or levofloxacin. There have been significant improvements (more potent regimens given over shorter periods of time) in the past several years for the treatment of highly drug resistant TB include use of the BPaL (bedaquiline, protamanid, levofloxacin) and BPaLM (BPaL plus moxifloxacin) regimens which require 6-9 months of therapy. +

+ Drug-resistant TB is a major challenge to global TB prevention and + control efforts and historically associated with a higher morbidity + and mortality compared to drug-susceptible disease. Multidrug (MDR) TB + is defined as resistance to at least isoniazid (INH) and rifampin + (RIF). Extensively drug resistant (XDR)-TB is defined as MDR-TB plus + resistance to a fluoroquinolone (FQN) drug and either bedaquiline or + levofloxacin. There have been significant improvements (more potent + regimens given over shorter periods of time) in the past several years + for the treatment of highly drug resistant TB include use of the BPaL + (bedaquiline, protamanid, levofloxacin) and BPaLM (BPaL plus + moxifloxacin) regimens which require 6-9 months of therapy.

-

Every culture-positive TB case for which an isolate is submitted to the state health department is subjected to whole-genome sequencing (WGS) through CDC. WGS data is used to identify and confirm recent transmission and supplement contact investigations done by the state and local health departments.

+

+ Every culture-positive TB case for which an isolate is submitted to + the state health department is subjected to whole-genome sequencing + (WGS) through CDC. WGS data is used to identify and confirm recent + transmission and supplement contact investigations done by the state + and local health departments. +

-

The State of Georgia had TB rates higher than the U.S. average for several decades, but rates have decreased significantly over the past decade, and currently Georgia has a TB incidence rate below the U.S. national average. In 2024, Georgia provisionally reported 253 new TB cases, compared to 246 in 2023. In 2023, Georgia had an incidence of 2.2 TB cases per 100,000 population which was below the US TB incidence of 2.9 cases per 100,000. Of the culture-confirmed TB cases tested for drug susceptibility in Georgia in 2023, 7.4% had resistance to INH, and only 2 cases were MDR. +

+ The State of Georgia had TB rates higher than the U.S. average for + several decades, but rates have decreased significantly over the past + decade, and currently Georgia has a TB incidence rate below the U.S. + national average. In 2024, Georgia provisionally reported 253 new TB + cases, compared to 246 in 2023. In 2023, Georgia had an incidence of + 2.2 TB cases per 100,000 population which was below the US TB + incidence of 2.9 cases per 100,000. Of the culture-confirmed TB cases + tested for drug susceptibility in Georgia in 2023, 7.4% had resistance + to INH, and only 2 cases were MDR.

- + - More than half of TB cases in Georgia occur in the metropolitan Atlanta area. + More than half of TB cases in Georgia occur in the metropolitan + Atlanta area. +
-
- + - - - + + + diff --git a/app/src/main/assets/pages/2_diagnostic_tests_for_latent_tb_infection_(ltbi).html b/app/src/main/assets/pages/2_diagnostic_tests_for_latent_tb_infection_(ltbi).html index bd8e89d..0774569 100644 --- a/app/src/main/assets/pages/2_diagnostic_tests_for_latent_tb_infection_(ltbi).html +++ b/app/src/main/assets/pages/2_diagnostic_tests_for_latent_tb_infection_(ltbi).html @@ -18,7 +18,7 @@
- +

II. Diagnostic Tests for Latent TB Infection (LTBI)

diff --git a/app/src/main/assets/pages/2_diagnostic_tests_for_latent_tb_infection_(ltbi)__a__tuberculin_skin_test.html b/app/src/main/assets/pages/2_diagnostic_tests_for_latent_tb_infection_(ltbi)__a__tuberculin_skin_test.html index 9c93ea0..52222eb 100644 --- a/app/src/main/assets/pages/2_diagnostic_tests_for_latent_tb_infection_(ltbi)__a__tuberculin_skin_test.html +++ b/app/src/main/assets/pages/2_diagnostic_tests_for_latent_tb_infection_(ltbi)__a__tuberculin_skin_test.html @@ -19,7 +19,7 @@
- +

II. Diagnostic Tests for Latent TB Infection (LTBI)

diff --git a/app/src/main/assets/pages/2_diagnostic_tests_for_latent_tb_infection_(ltbi)__b__criteria_for_a_positive_tuberculin_test_by_risk_group.html b/app/src/main/assets/pages/2_diagnostic_tests_for_latent_tb_infection_(ltbi)__b__criteria_for_a_positive_tuberculin_test_by_risk_group.html index 34b38f6..6ba2837 100644 --- a/app/src/main/assets/pages/2_diagnostic_tests_for_latent_tb_infection_(ltbi)__b__criteria_for_a_positive_tuberculin_test_by_risk_group.html +++ b/app/src/main/assets/pages/2_diagnostic_tests_for_latent_tb_infection_(ltbi)__b__criteria_for_a_positive_tuberculin_test_by_risk_group.html @@ -18,7 +18,7 @@
- +

II. Diagnostic Tests for Latent TB Infection (LTBI)

@@ -28,7 +28,7 @@
- Reaction ≥ 5 mm of induration⌃ +

Reaction ≥ 5 mm of induration⌃

  • Persons living with Human Immunodeficiency Virus (HIV)
    • @@ -41,7 +41,7 @@
- Reaction ≥ 10 mm of induration⌃ +

Reaction ≥ 10 mm of induration⌃

  • Recent immigrants to the U.S. (within the last 5 years) who came from high TB incidence countries
    • @@ -66,7 +66,7 @@
  • Recent TST conversion (increase of > 10 mm of induration within the past 2 years)
- Reaction ≥ 15 mm of induration⌃ +

Reaction ≥ 15 mm of induration⌃

  • Persons with no risk factors for TB (ideally such persons diff --git a/app/src/main/assets/pages/2_diagnostic_tests_for_latent_tb_infection_(ltbi)__c__two_step_testing_and_the_booster_reaction.html b/app/src/main/assets/pages/2_diagnostic_tests_for_latent_tb_infection_(ltbi)__c__two_step_testing_and_the_booster_reaction.html index 46c6f50..c56be45 100644 --- a/app/src/main/assets/pages/2_diagnostic_tests_for_latent_tb_infection_(ltbi)__c__two_step_testing_and_the_booster_reaction.html +++ b/app/src/main/assets/pages/2_diagnostic_tests_for_latent_tb_infection_(ltbi)__c__two_step_testing_and_the_booster_reaction.html @@ -19,7 +19,7 @@
    - +

    II. Diagnostic Tests for Latent TB Infection (LTBI)

    diff --git a/app/src/main/assets/pages/2_diagnostic_tests_for_latent_tb_infection_(ltbi)__d__anergy_testing.html b/app/src/main/assets/pages/2_diagnostic_tests_for_latent_tb_infection_(ltbi)__d__anergy_testing.html index f334bc9..9eb0269 100644 --- a/app/src/main/assets/pages/2_diagnostic_tests_for_latent_tb_infection_(ltbi)__d__anergy_testing.html +++ b/app/src/main/assets/pages/2_diagnostic_tests_for_latent_tb_infection_(ltbi)__d__anergy_testing.html @@ -19,7 +19,7 @@
    - +

    II. Diagnostic Tests for Latent TB Infection (LTBI)

    diff --git a/app/src/main/assets/pages/2_diagnostic_tests_for_latent_tb_infection_(ltbi)__e__interferon_y_release_assays_(igras).html b/app/src/main/assets/pages/2_diagnostic_tests_for_latent_tb_infection_(ltbi)__e__interferon_y_release_assays_(igras).html index 1568bbf..a92d1ad 100644 --- a/app/src/main/assets/pages/2_diagnostic_tests_for_latent_tb_infection_(ltbi)__e__interferon_y_release_assays_(igras).html +++ b/app/src/main/assets/pages/2_diagnostic_tests_for_latent_tb_infection_(ltbi)__e__interferon_y_release_assays_(igras).html @@ -58,6 +58,7 @@

    Table 1. Interpretation Criteria for the QuantiFERON-TB Gold Plus Test (QFT-Plus)

    +

    Possible Test Results

      • @@ -68,198 +69,205 @@

      Table 1. Interpretation Criteria for

- - - - - - - - - - - - - - - - - - - - - - + + + + + + + + + + + + + + + + + + + + + +
Nil (IU/ml) < 8.0
TB1 minus Nil (IU/ml)> 0.35 and > 25% of NilAny
TB2 minus Nil (IU/ml)Any> 0.35 and > 25% of Nil
Mitogen minus NilAny
Report/InterpretationM. tuberculosis infection likely
Nil (IU/ml) < 8.0
TB1 minus Nil (IU/ml)> 0.35 and > 25% of NilAny
TB2 minus Nil (IU/ml)Any> 0.35 and > 25% of Nil
Mitogen minus NilAny
Report/InterpretationM. tuberculosis infection likely
- +
- - - - - - - - - - - - - - - - - - - - - + + + + + + + + + + + + + + + + + + + + +
Nil (IU/ml) < 8.0
TB1 minus Nil (IU/ml)< 0.35 or > 0.35 and < 25 % of Nil
TB2 minus Nil (IU/ml)< 0.35 or > 0.35 and < 25% of Nil
Mitogen minus Nil > 0.50
Report/InterpretationM. tuberculosis infection not likely
Nil (IU/ml) < 8.0
TB1 minus Nil (IU/ml)< 0.35 or > 0.35 and < 25 % of Nil
TB2 minus Nil (IU/ml)< 0.35 or > 0.35 and < 25% of Nil
Mitogen minus Nil > 0.50
Report/InterpretationM. tuberculosis infection not likely
- - - - - - - - - - - - - - - - - - - - - - - - + + + + + + + + + + + + + + + + + + + + + + + +
Nil (IU/ml) < 8.0> 8.0
TB1 minus Nil (IU/ml)< 0.35 or > 0.35 and < 25% of NilAny
TB2 minus Nil (IU/ml)< 0.35 or > 0.35 and < 25% of NilAny
Mitogen minus Nil < 0.50Any
Report/InterpretationLikelihood of M. tuberculosis infection cannot be determined
Nil (IU/ml) < 8.0> 8.0
TB1 minus Nil (IU/ml)< 0.35 or > 0.35 and < 25% of NilAny
TB2 minus Nil (IU/ml)< 0.35 or > 0.35 and < 25% of NilAny
Mitogen minus Nil < 0.50Any
Report/InterpretationLikelihood of M. tuberculosis infection cannot be determined

Source: Based on manufacturer recommendations for QuantiFERON-TB Gold Plus [Package insert].
Available at: - - https://www.qiagen.com/us/resources/download.aspx?id=ac068fc7-a994-4443-ac7c-dda43ce2bc5e&lang=en + + https://www.qiagen.com/us/resources/resource?id=ac068fc7-a994-4443-ac7c-dda43ce2bc5e&lang=en

- +

Table 2. Interpretation Criteria for the T-SPOT.TB Test (T-Spot)

    -
    • -
    • -
    • -
    • +
    • +
    • +
    • +
- - - - - - - - - - - - + + + + + + + + + + + + +
Nil*≤ 10 spots
TB Response†≥ 8 spots
Mitogen§Any
Nil + i≤ 10 spots
TB Response + i≥ 8 spots
Mitogen + i + Any
- - - - - - - - - - - - - + + + + + + + + + + + +
Nil*< 10 spots
TB Response†5, 6, or 7 spots
Mitogen§Any
Nil + i + < 10 spots
TB Response + i + 5, 6, or 7 spots
Mitogen + i + Any
- +
- - - - - - - - - - - - + + + + + + + + + + + +
Nil*≤ 10 spots
TB Response†> 20 spots
Mitogen§> 20 spots
Nil + i + ≤ 10 spots
TB Response + i + > 20 spots
Mitogen + i + > 20 spots
- +
- - - - - - - - - - - - - - - + + + + + + + + + + + + + + +
Nil*≤ 10 spots≤ 10 spots
TB Response†Any< 5 spots
Mitogen§Any< 20 spots
Nil + i + ≤ 10 spots≤ 10 spots
TB Response + i + Any< 5 spots
Mitogen + i + Any< 20 spots
-

- Source: Based on Oxford Immunotec T-Spot.TB package insert.
- Available at: - https://www.tspot.com/wp-content/uploads/2021/04/TB-PI-US-0001-V9.pdf - -

- -

* The number of spots resulting from incubation of PBMCs in culture media without antigens.
- † The greater number of spots resulting from stimulation of peripheral - blood mononuclear cells (PBMCs) with two separate cocktails of peptides - representing early secretory antigenic target-6 (ESAT-6) or culture filtrate - protein-10 (CFP-10) minus Nil.
- § The number of spots resulting from stimulation of PBMCs with mitogen - without adjustment for the number of spots resulting from incubation of - PBMCs without antigens.
- ¶ Interpretation indicating that Mycobacterium tuberculosis infection is - likely.
- ** Interpretation indicating an uncertain likelihood of M. tuberculosis infection. In the case of Invalid - results, these should be reported as “Invalid” - and it is recommended to collect another sample and retest the individual.
- †† Interpretation indicating that M. tuberculosis infection is not likely.

+

Source: Based on Oxford Immunotec T-Spot.TB package insert.
+ Available at: + http://www.oxfordimmunotec.com/international/wp-content/uploads/sites/3/Final-File-PI-TB-US-V6.pdf +

+

1. Interpretation indicating that Mycobacterium tuberculosis infection is likely.
+ 2. Interpretation indicating an uncertain likelihood of M. tuberculosis infection. In the case of Invalid results, these should be reported as “Invalid” and it is recommended to collect another sample and retest the individual.
+ 3. Interpretation indicating that M. tuberculosis infection is not likely.

@@ -267,4 +275,5 @@

Table 2. Interpretation Criteria for + diff --git a/app/src/main/assets/pages/2_diagnostic_tests_for_latent_tb_infection_(ltbi)__f__targeted_testing_and_diagnostic_tests_for_ltbi.html b/app/src/main/assets/pages/2_diagnostic_tests_for_latent_tb_infection_(ltbi)__f__targeted_testing_and_diagnostic_tests_for_ltbi.html index 088b287..2a169cd 100644 --- a/app/src/main/assets/pages/2_diagnostic_tests_for_latent_tb_infection_(ltbi)__f__targeted_testing_and_diagnostic_tests_for_ltbi.html +++ b/app/src/main/assets/pages/2_diagnostic_tests_for_latent_tb_infection_(ltbi)__f__targeted_testing_and_diagnostic_tests_for_ltbi.html @@ -35,28 +35,28 @@ disease (see Table 3).

- People living with HIV who have LTBI⌃ + People living with HIV who have LTBI⌃
  • are at the greatest risk of progressing to active TB disease (at rates up to 8 -10% per year). All persons living with HIV should undergo testing for LTBI, and if LTBI is found, should strongly be encouraged to initiate and complete treatment for LTBI.
- Patients who take immunomodulating drugs⌃ + Patients who take immunomodulating drugs⌃
  • are also at increased risk for progression to active TB disease if infected with M. tuberculosis. This includes patients with LTBI who are treated with TNF-α inhibitors such as infliximab (Remicade), etanercept (Enbrel), adalimumab (Humira), certolizumab pegol (Cimzia), or golimumab (Simponi). Following the initial introduction of TNF-α inhibitor drugs, there were reports of the subsequent development of extrapulmonary and disseminated disease and in some cases, death.
- All patients who will be treated with TNF-α inhibitor drugs⌃ + All patients who will be treated with TNF-α inhibitor drugs⌃
  • should be screened for LTBI before starting the medication; if found to have LTBI, they should be started on therapy for LTBI (after active TB disease is excluded) before starting the TNF-α inhibitor. Whether treatment for LTBI should be completed before a TNF-α inhibitor is started is controversial.
- Patients preparing to receive a solid organ transplant⌃ + Patients preparing to receive a solid organ transplant⌃
  • should also be screened for LTBI.
    • @@ -64,7 +64,7 @@
- Current clinical practice among experts is to use targeted testing for LTBI based on epidemiologic risk factors.⌃ + Current clinical practice among experts is to use targeted testing for LTBI based on epidemiologic risk factors.⌃
  • Children less than 5 years of age are at increased risk for progression to active TB disease if infected but should not be tested for LTBI unless they are at increased risk for TB exposure (see Table 3 ).
    • @@ -77,65 +77,65 @@

Who should be targeted for LTBI testing?

- +

Diagnostic tests for LTBI are not recommended for people with low risk of M. tuberculosis infection. Testing of low-risk persons can result in false-positive tests.

- - Certain persons with increased risk of developing TB if they have LTBI should be targeted for testing. These include:⌃ + + Certain persons with increased risk of developing TB if they have LTBI should be targeted for testing. These include:⌃
    -
  • People who have spent time with someone who has TB disease (contacts of active TB cases)
    • -
  • People living with HIV or those who have other immunecompromising illnesses.
    • -
  • - Immigrants from high TB incidence countries (e.g., Asia, Africa, most countries in Latin America, the Caribbean, Eastern Europe, and Russia) -
    • -
  • People who live or work somewhere in the United States where TB disease is more common (homeless shelters, - correctional facilities including prisons and jails, or some nursing homes) -
    • -
  • People with substance use disorders including persons who inject drugs
    • -
  • People who are preparing to initiate treatment with a TNF-α inhibitor.
    • -
  • People preparing to receive a solid organ transplant or hematopoetic stem cell transplant.
    • +
  • People who have spent time with someone who has TB disease (contacts of active TB cases)
    • +
  • People living with HIV or those who have other immunecompromising illnesses.
    • +
  • + Immigrants from high TB incidence countries (e.g., Asia, Africa, most countries in Latin America, the Caribbean, Eastern Europe, and Russia) +
    • +
  • People who live or work somewhere in the United States where TB disease is more common (homeless shelters, + correctional facilities including prisons and jails, or some nursing homes) +
    • +
  • People with substance use disorders including persons who inject drugs
    • +
  • People who are preparing to initiate treatment with a TNF-α inhibitor.
    • +
  • People preparing to receive a solid organ transplant or hematopoetic stem cell transplant.

U.S. Preventive Services Task Force (USPSTF) Recommendations for Screening for Latent TB Infection (LTBI):⌃

-
    -
  • The U.S. Preventive Services Task Force (USPSTF) recommends - testing populations that are at increased risk for TB infection -

    - - (https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/latent-tuberculosis-infection-screening) -

    -
    • -
  • - This is a “B” recommendation (“offer or provide this - service”) indicating that given the current evidence, the USPSTF - has concluded with moderate certainty that benefits of screening - for LTBI in people who are at increased risk of infection outweigh - the potential harms.
    • +
      +
    • The U.S. Preventive Services Task Force (USPSTF) recommends + testing populations that are at increased risk for TB infection +

      + + (https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/latent-tuberculosis-infection-screening) +

      +
      • +
    • + This is a “B” recommendation (“offer or provide this + service”) indicating that given the current evidence, the USPSTF + has concluded with moderate certainty that benefits of screening + for LTBI in people who are at increased risk of infection outweigh + the potential harms.
      • -
    • - However, the highest-risk populations and thus those with the greatest benefit for targeted screening and treatment (persons living with HIV, close contacts of persons with active TB, and those being treated with immunosuppressive - agents such as TNF-α inhibitors) were excluded from the USPSTF - review of evidence because “screening in these populations may - be considered standard care as part of disease management or - indicated prior to the use of certain medications.” -
      • +
    • + However, the highest-risk populations and thus those with the greatest benefit for targeted screening and treatment (persons living with HIV, close contacts of persons with active TB, and those being treated with immunosuppressive + agents such as TNF-α inhibitors) were excluded from the USPSTF + review of evidence because “screening in these populations may + be considered standard care as part of disease management or + indicated prior to the use of certain medications.” +
      • -
    • - Once these highest-risk groups which should be screened for LTBI are removed, patients considered high risk in the primary - care setting that should be screened for LTBI include non-U.S. born persons - who have immigrated to the U.S. from high burden TB countries. -
      • +
    • + Once these highest-risk groups which should be screened for LTBI are removed, patients considered high risk in the primary + care setting that should be screened for LTBI include non-U.S. born persons + who have immigrated to the U.S. from high burden TB countries. +
      • -
    • - - High-risk groups for TB infection that should be targeted for - testing and treatment are outlined above and also listed in - Table 3. -
      • -
    +
  • + + High-risk groups for TB infection that should be targeted for + testing and treatment are outlined above and also listed in + Table 3. +
    • +

Table 3. High Prevalence and High-Risk Groups

@@ -149,7 +149,7 @@

Table 3. High Prevalence and High-Ris Persons born in countries with high rates of TB - Persons living with HIV Persons who are close contacts of persons with infectious active TB + Persons living with HIV Persons who are close contacts of persons with infectious active TB @@ -159,7 +159,7 @@

Table 3. High Prevalence and High-Ris Persons who live or spend time in certain facilities (e.g., nursing homes, correctional institutions, - homeless shelters, drug treatment centers) + homeless shelters, drug treatment centers) Persons with recent infection with M. tuberculosis (e.g., have had a diagnostic test result for LTBI convert to positive in the past 1-2 years) Persons who have chest radiographs suggestive of old TB @@ -167,12 +167,13 @@

Table 3. High Prevalence and High-Ris Persons who inject drugs - Persons with certain medical conditions* + Persons with certain medical conditions i *Diabetes mellitus, silicosis, prolonged therapy with corticosteroids, immunosuppressive therapy particularly TNF-α blockers, leukemia, Hodgkin’s disease, head and neck cancers, - severe kidney disease, certain intestinal conditions, malnutrition + severe kidney disease, certain intestinal conditions, malnutrition @@ -186,7 +187,7 @@

Table 3. High Prevalence and High-Ris tests can yield different results. Studies which employed multiple diagnostic tests have demonstrated that discordant test results are not uncommon.

- +

Which diagnostic test for LTBI should be used?

General Recommendations for Use of Diagnostic Tests for LTBI: ⌃ @@ -247,38 +248,39 @@

Table 3. High Prevalence and High-Ris

Situations in which a TST or IGRA may be used without preference: ⌃
-
    -
  • Contact investigations (i.e., testing of recent contacts of persons known or suspected to have active TB disease) -
    • -
+
    +
  • Contact investigations (i.e., testing of recent contacts of persons known or suspected to have active TB disease) +
    • +
Situations in which testing with both an IGRA and a TST may be considered: ⌃
-
    -
  • When additional evidence of infection is required to encourage a person that they have LTBI and should take and adhere to therapy for LTBI (e.g., non-US born health care worker who believes that their positive TST result is attributable to BCG) -
    • -
  • When the initial diagnostic test performed in a healthy person at low risk for both infection and - progression is positive - (and thought to be a false positive). This situation could be - prevented by using targeted testing and not testing low risk - individuals. -
    • -
  • Repeating an IGRA or performing a TST might be useful - when the initial IGRA result is indeterminate, borderline, or - invalid and a reason for testing persists. -
    • -
  • In selected very high-risk individuals when missing the presence of LTBI could have serious consequences - (e.g., individuals to be started on a TNF-α blocker or other immunocompromising medications). -
    • -
-
- +
+ +
+ diff --git a/app/src/main/assets/pages/2_diagnostic_tests_for_latent_tb_infection_(ltbi)__g__medical_evaluation_after_testing_for_ltbi.html b/app/src/main/assets/pages/2_diagnostic_tests_for_latent_tb_infection_(ltbi)__g__medical_evaluation_after_testing_for_ltbi.html index d1e8a3f..6e3e412 100644 --- a/app/src/main/assets/pages/2_diagnostic_tests_for_latent_tb_infection_(ltbi)__g__medical_evaluation_after_testing_for_ltbi.html +++ b/app/src/main/assets/pages/2_diagnostic_tests_for_latent_tb_infection_(ltbi)__g__medical_evaluation_after_testing_for_ltbi.html @@ -19,7 +19,7 @@
- +

II. Diagnostic Tests for Latent TB Infection (LTBI)

diff --git a/app/src/main/assets/pages/2_diagnostic_tests_for_latent_tb_infection_(ltbi)__h__reporting_of_pediatric_positive_tests_for_ltbi.html b/app/src/main/assets/pages/2_diagnostic_tests_for_latent_tb_infection_(ltbi)__h__reporting_of_pediatric_positive_tests_for_ltbi.html index 5563ebb..35cca92 100644 --- a/app/src/main/assets/pages/2_diagnostic_tests_for_latent_tb_infection_(ltbi)__h__reporting_of_pediatric_positive_tests_for_ltbi.html +++ b/app/src/main/assets/pages/2_diagnostic_tests_for_latent_tb_infection_(ltbi)__h__reporting_of_pediatric_positive_tests_for_ltbi.html @@ -19,7 +19,7 @@
- +

II. Diagnostic Tests for Latent TB Infection (LTBI)

diff --git a/app/src/main/assets/pages/3_treatment_of_latent_tb_infection_(ltbi).html b/app/src/main/assets/pages/3_treatment_of_latent_tb_infection_(ltbi).html index b907264..3b27c17 100644 --- a/app/src/main/assets/pages/3_treatment_of_latent_tb_infection_(ltbi).html +++ b/app/src/main/assets/pages/3_treatment_of_latent_tb_infection_(ltbi).html @@ -19,7 +19,7 @@
- +

III. Treatment of Latent TB Infection (LTBI)

diff --git a/app/src/main/assets/pages/3_treatment_of_latent_tb_infection_(ltbi)__a__treatment_regimens.html b/app/src/main/assets/pages/3_treatment_of_latent_tb_infection_(ltbi)__a__treatment_regimens.html index 6c3a942..f9d6ad9 100644 --- a/app/src/main/assets/pages/3_treatment_of_latent_tb_infection_(ltbi)__a__treatment_regimens.html +++ b/app/src/main/assets/pages/3_treatment_of_latent_tb_infection_(ltbi)__a__treatment_regimens.html @@ -1,428 +1,764 @@ - + - - - - - Treatment Regimens - - - - - - - - -
-
+ + + + + Treatment Regimens + + + + + + + + + +
+
-
-
- -
-

III. Treatment of Latent TB Infection (LTBI)

+
+
+
-

Last Updated October 2025

+

+ III. Treatment of Latent TB Infection (LTBI) +

+
+

Last Updated October 2025

-
-
- -

- Treatment regimens for LTBI are outlined in Table 4. Several - different LTBI treatment regimens are recommended by CDC and the National Tuberculosis Coalition of America (NTCA). -

- -

These include:

- -
    +
    +
+ +

+ Treatment regimens for LTBI are outlined in + Table 4. Several different LTBI treatment regimens + are recommended by CDC and the National Tuberculosis Coalition of + America (NTCA). +

+ +

These include:

+ +
  • - - Rifampin⌃ - - -
    - Rifampin for 4 months is a preferred CDC treatment regimen for the treatment of LTBI among persons presumed to be infected with drug-susceptible TB (isoniazid [INH] and rifampin susceptible) and is the regimen of choice for the treatment of LTBI among persons thought to be infected with INH-resistant strains - of M. tuberculosis. Rifampin is also preferred by many clinicians and public health clinics because of the shorter duration of therapy compared to INH and because rifampin has less hepatotoxicity compared to INH for the treatment of LTBI. - - Rifampin for 4 months has been shown to be noninferior to 9 months of INH for the treatment of LTBI in a randomized controlled trial. In addition, rifampin was associated with higher completion rates and fewer adverse effects compared to INH. Rifampin has a large number of drug -drug interactions (as discussed on page 78) - including warfarin, oral contraceptives, azole antifungals, and HIV antiretroviral therapy. Other medications that a person with LTBI is taking is an important consideration when determining whether rifampin or other LTBI regimens which include rifampin or other rifamycins can be prescribed. Drug-drug interactions between - rifamycins and antiretroviral therapy are regularly updated by the U.S. Department of Health and Human Services - (for LTBI regimens and rifampin/rifamycins: https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-opportunistic-infections/mycobacterium ); - rifampin and antiretroviral drug interactions: https://clinicalinfo.hiv.gov/sites/default/files/guidelines/documents/adult-adolescent-arv/guidelines-adult-adolescent-arv.pdf -
    + + Rifampin⌃ + + +
    + Rifampin for 4 months is a preferred CDC treatment regimen for the + treatment of LTBI among persons presumed to be infected with + drug-susceptible TB (isoniazid [INH] and rifampin susceptible) and + is the regimen of choice for the treatment of LTBI among persons + thought to be infected with INH-resistant strains of M. + tuberculosis. Rifampin is also preferred by many clinicians and + public health clinics because of the shorter duration of therapy + compared to INH and because rifampin has less hepatotoxicity + compared to INH for the treatment of LTBI. Rifampin for 4 months has + been shown to be noninferior to 9 months of INH for the treatment of + LTBI in a randomized controlled trial. In addition, rifampin was + associated with higher completion rates and fewer adverse effects + compared to INH. Rifampin has a large number of drug -drug + interactions (as discussed on page 78) including warfarin, oral + contraceptives, azole antifungals, and HIV antiretroviral therapy. + Other medications that a person with LTBI is taking is an important + consideration when determining whether rifampin or other LTBI + regimens which include rifampin or other rifamycins can be + prescribed. Drug-drug interactions between rifamycins and + antiretroviral therapy are regularly updated by the U.S. Department + of Health and Human Services (for LTBI regimens and + rifampin/rifamycins: + https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-opportunistic-infections/mycobacterium + ); rifampin and antiretroviral drug interactions: + https://clinicalinfo.hiv.gov/sites/default/files/guidelines/documents/adult-adolescent-arv/guidelines-adult-adolescent-arv.pdf +
    • -
  • INH plus Rifapentine (3HP) ⌃ -
    -

    A short course regimen of weekly INH plus rifapentine for 12 weekly doses is another CDC-preferred - regimen for the treatment of LTBI (due to presumed infection with drug-susceptible M. tuberculosis) in adults as well as children > 2 years of age. - In 2011, when CDC first recommended 3HP for the treatment of LTBI it indicated it should be delivered by directly observed therapy [DOT]. However, based on further studies and updated data, CDC revised guidelines for the use of 3HP in 2018 expanded the patient populations for which this regimen could be used and included an option for self-administration of the 3HP regimen. CDC recommendations for 3HP in the treatment of LTBI include:

    -
      -
    • use of 3HP in adults and persons aged 2–17 years with - LTBI; -
      • -
    • use of 3HP in persons who are living with HIV with - LTBI including those with AIDS and taking antiretroviral medications with acceptable drug-drug - interactions with rifapentine* [the 2021 DHHS guidelines on treatment of HIV among adults and - adolescents indicate that rifapentine as part of a 3HP regimen is acceptable to use among persons - living with HIV on and ART regimen that includes once daily dolutegravir]; and -
      • -
    • - use of 3HP by directly observed therapy (DOT) or self-administered - therapy (SAT) in persons aged ≥ 2 - years. Per CDC recommendations, “the health care - provider should choose the mode of administration - (DOT versus SAT) based on local practice, individual - patient attributes and preferences, and other considerations, including risk for progression to - severe - forms of TB disease” (MMWR 2018; 67:723-72). - -
      • -
    -

    - The 3HP is regimen is NOT recommended for pregnant women, children < 2 years old, persons living with HIV who are on antiretroviral - drugs that have significant drug-drug interactions with rifapentine, or patients infected with suspected INH-resistant, - rifampin-resistant, or multidrug resistant (MDR) isolates. Other potential challenges in using the 3HP regimen in addition to - the drug-drug interactions due to rifapentine (similar to those seen with other rifamycin drugs such as rifampin) include cost of - medications that are greater than most alternatives; the need to take numerous pills simultaneously (10 pills once weekly - compared with two or three pills daily for other regimens for most adults); and the association with a systemic drug - reaction or influenza-like syndrome that can include syncope and hypotension (although the risk of hospitalization is low, 0.1% in published studies). -

    -
    +
  • + INH plus Rifapentine (3HP) + ⌃ +
    +

    + A short course regimen of weekly INH plus rifapentine for 12 + weekly doses is another CDC-preferred regimen for the treatment of + LTBI (due to presumed infection with drug-susceptible M. + tuberculosis) in adults as well as children > 2 years of age. In + 2011, when CDC first recommended 3HP for the treatment of LTBI it + indicated it should be delivered by directly observed therapy + [DOT]. However, based on further studies and updated data, CDC + revised guidelines for the use of 3HP in 2018 expanded the patient + populations for which this regimen could be used and included an + option for self-administration of the 3HP regimen. CDC + recommendations for 3HP in the treatment of LTBI include: +

    +
      +
    • + use of 3HP in adults and persons aged 2–17 years with LTBI; +
      • +
    • + use of 3HP in persons who are living with HIV with LTBI + including those with AIDS and taking antiretroviral medications + with acceptable drug-drug interactions with rifapentine* [the + 2021 DHHS guidelines on treatment of HIV among adults and + adolescents indicate that rifapentine as part of a 3HP regimen + is acceptable to use among persons living with HIV on and ART + regimen that includes once daily dolutegravir]; and +
      • +
    • + use of 3HP by directly observed therapy (DOT) or + self-administered therapy (SAT) in persons aged ≥ 2 years. Per + CDC recommendations, “the health care provider should choose the + mode of administration (DOT versus SAT) based on local practice, + individual patient attributes and preferences, and other + considerations, including risk for progression to severe forms + of TB disease” (MMWR 2018; 67:723-72). +
      • +
    +

    + The 3HP is regimen is NOT recommended for pregnant women, children + < 2 years old, persons living with HIV who are on antiretroviral + drugs that have significant drug-drug interactions with + rifapentine, or patients infected with suspected INH-resistant, + rifampin-resistant, or multidrug resistant (MDR) isolates. Other + potential challenges in using the 3HP regimen in addition to the + drug-drug interactions due to rifapentine (similar to those seen + with other rifamycin drugs such as rifampin) include cost of + medications that are greater than most alternatives; the need to + take numerous pills simultaneously (10 pills once weekly compared + with two or three pills daily for other regimens for most adults); + and the association with a systemic drug reaction or + influenza-like syndrome that can include syncope and hypotension + (although the risk of hospitalization is low, 0.1% in published + studies). +

    +
    • -
  • Isoniazid (INH) ⌃ -
    -

    - In the CDC 2020 LTBI treatment guidelines, 6 or 9 months of daily INH is a recommended alternative regimen for the treatment of - LTBI (due to presumed infection with drug susceptible M. tuberculosis) as shown in Table 4. A regimen of 6 months of daily INH - is strongly recommended for HIV-negative adults and children of all ages and conditionally recommended for adults living with - HIV and children of all ages; INH daily for 9 months is conditionally recommended for adults and children of all ages, both - HIV-seronegative and HIV-positive. One practical approach for the use of INH for LTBI is to aim for a 9 month regimen with the - goal of completion of at least 6 months. INH can be given daily (e.g., by self-administered therapy) as outlined in Table 5. - INH should be used for the treatment of LTBI when there are serious potential drug-drug interactions with rifampin or other rifamycins. -

    -
    +
  • + Isoniazid (INH) ⌃ +
    +

    + In the CDC 2020 LTBI treatment guidelines, 6 or 9 months of daily + INH is a recommended alternative regimen for the treatment of LTBI + (due to presumed infection with drug susceptible M. tuberculosis) + as shown in Table 4. A regimen of 6 months + of daily INH is strongly recommended for HIV-negative adults and + children of all ages and conditionally recommended for adults + living with HIV and children of all ages; INH daily for 9 months + is conditionally recommended for adults and children of all ages, + both HIV-seronegative and HIV-positive. One practical approach for + the use of INH for LTBI is to aim for a 9 month regimen with the + goal of completion of at least 6 months. INH can be given daily + (e.g., by self-administered therapy) as outlined in + Table 5. INH should be used for the + treatment of LTBI when there are serious potential drug-drug + interactions with rifampin or other rifamycins. +

    +
    • -
  • Isoniazid (INH) plus Rifampin ⌃ -
    - A regimen of 3 months of - daily INH plus daily rifampin is a CDC conditionally recommended regimen for the treatment of LTBI in adults - and - children of all ages. Because this regimen contains rifampin, - clinicians must closely review other medications that a person with LTBI is on to assess whether there are - drug-drug - interactions that would prohibit the use of this regimen (as - discussed above for rifampin). -
    +
  • + Isoniazid (INH) plus Rifampin + ⌃ +
    + A regimen of 3 months of daily INH plus daily rifampin is a CDC + conditionally recommended regimen for the treatment of LTBI in + adults and children of all ages. Because this regimen contains + rifampin, clinicians must closely review other medications that a + person with LTBI is on to assess whether there are drug-drug + interactions that would prohibit the use of this regimen (as + discussed above for rifampin). +
    • -
+ - Pills + Pills -

Table 4. Recommendations for regimens to treat latent tuberculosis infection

+

+ Table 4. Recommendations for regimens to treat latent tuberculosis + infection +

-
+
-
    -
    • -
    • -
+
    +
  • + +
    • +
  • + +
    • +
- - +
+ + + + + + + - - - - + + + + - - - - + + + + - - - - + + + + - +
Regimes3 months isoniazid plus rifapentine4 months rifampin3 months isoniazid plus rifampin
Regimes3 months isoniazid plus rifapentine given once weekly4 months rifampin given daily3 months isoniazid plus rifampin given dailyFrequencyOnce weeklyDailyDaily
Recommendation (Strong or Conditional)StrongStrongConditionalRecommendation (Strong or Conditional)StrongStrongConditional
Evidence (High, Moderate, Low, or Very Low)ModerateModerate (HIV negative) † Very low (HIV negative) † Evidence (High, Moderate, Low, or Very Low)Moderate + Moderate (HIV negative) + i + + Very low (HIV negative) / Low (HIV positive) + i +
- - +
+ - - - - + + + + - - - - + + + + - - - - + + + + - + + + + + + +
Regimes6 months isoniazid given daily9 months isoniazid given daily3 months isoniazid plus rifampin given dailyRegimes6 months isoniazid6 months isoniazid9 months isoniazid
Recommendation (Strong or Conditional)Strong §ConditionalConditionalFrequencyDailyDailyDaily
Evidence (High, Moderate, Low, or Very Low)Moderate (HIV negative)Moderate (if living with HIV)ModerateRecommendation (Strong or Conditional) + Strong + i + ConditionalConditional
Evidence (High, Moderate, Low, or Very Low)Moderate (HIV negative)Moderate (if living with HIV)Moderate
- - -
- -

Abbreviation: HIV = human immunodeficiency virus
- * Preferred: excellent tolerability and efficacy, shorter treatment duration, - higher completion rates than longer regimens, and therefore higher - effectiveness. Alternative: excellent efficacy but concerns regarding longer - treatment duration, lower completion rates, and therefore lower effectiveness. -
† No evidence reported in HIV-positive persons.
- § Strong recommendation for those persons unable to take a preferred - regimen (e.g., due to drug intolerability or drug-drug interactions). -

- -

Table 5. Dosages for Recommended LTBI Treatment Regimens

- - + +

Abbreviation: HIV = human immunodeficiency virus

+

+ 1. Preferred: excellent tolerability and efficacy, shorter treatment + duration, higher completion rates than longer regimens, and therefore + higher effectiveness.
+ 2. Alternative: excellent efficacy but concerns regarding longer + treatment duration, lower completion rates, and therefore lower + effectiveness. +

+ +

+ Table 5. Dosages for Recommended LTBI Treatment Regimens +

+ + - -

- * Isoniazid is formulated as 100-mg and 300-mg tablets. † Rifapentine is formulated as 150-mg tablets in blister packs that should be kept sealed until use. Rifapentine should not be used for children <2 years of age due to lack of pharmacokinetic data.¶ Rifampin (rifampicin) is formulated as 150-mg and 300-mg capsules. 
 ** The American Academy of Pediatrics acknowledges that some experts use rifampin at 20 - 30 mg/kg for the daily regimen when prescribing for infants and toddlers. (Source: American Academy of Pediatrics. Tuberculosis. In: Kimberlin DW, Brady MT, Jackson MA, Long SS, eds. Red Book: 2018 Report of the Committee on Infectious Diseases. 31st ed. Itasca, IL: American Academy of Pediatrics; 2018:829-53). †† The American Academy of Pediatrics recommends an isoniazid dosage of 10 - 15 mg/kg for the daily regimen. Adapted from MMWR Recomm Rep 2020; 69(1):1-11. -

- -

Table 6. LTBI Treatment Drug Adverse Reactions

-
+
+ +

+ 1. Isoniazid is formulated as 100-mg and 300-mg tablets.
+ 2. Rifapentine is formulated as 150-mg tablets in blister packs that + should be kept sealed until use. Rifapentine should not be used for + children <2 years of age due to lack of pharmacokinetic data.
+ 3. Rifampin (rifampicin) is formulated as 150-mg and 300-mg capsules. +

+ +

+ Table 6. LTBI Treatment Drug Adverse Reactions +

+
-
    -
    • -
    • -
    • -
+
    +
  • + +
    • +
  • + +
    • +
  • + +
    • +
- - +
+ - - + + - - + + - - + + - +
Adverse Reactions - Gastrointestinal (GI) upset, hepatic enzyme elevations, hepatitis, peripheral neuropathy, mild effects on central nervous system (CNS), drug interactions - Adverse Reactions + Gastrointestinal (GI) upset, hepatic enzyme elevations, + hepatitis, peripheral neuropathy, mild effects on central + nervous system (CNS), drug interactions +
- Monitoring - - Order baseline hepatic chemistry blood tests (at least AST or ALT) for patients with specific conditions: Living with HIV, liver disorders, postpartum period (<3 months after delivery), regular alcohol use, injection drug use, or use of medications with known possible interactions. [Some clinicians prefer to obtain baseline tests on all adults]. Repeat measurements if: * baseline results are abnormal * client is at high-risk for adverse reactions * client has symptoms of adverse reactions - Monitoring + Order baseline hepatic chemistry blood tests (at least AST or + ALT) for patients with specific conditions: Living with HIV, + liver disorders, postpartum period (<3 months after delivery), + regular alcohol use, injection drug use, or use of medications + with known possible interactions. [Some clinicians prefer to + obtain baseline tests on all adults]. Repeat measurements if: + baseline results are abnormal + client is at high-risk for adverse reactions + client has symptoms of adverse reactions +
- Comments - - Hepatitis risk increases with age and alcohol consumption. Pyridoxine can prevent isoniazid-induced peripheral neuropathy. - Comments + Hepatitis risk increases with age and alcohol consumption. + Pyridoxine can prevent isoniazid-induced peripheral neuropathy. +
- - +
+ - - + + - - + + - - + + - +
Adverse Reactions - Orange discoloration of body fluids (secretions, tears, urine) , GI upset, drug interactions, hepatitis, thrombocytopenia, rash, fever, influenza-like symptoms, hypersensitivity reaction* Many drug-drug interactions - Adverse Reactions + Orange discoloration of body fluids (secretions, tears, urine) , + GI upset, drug interactions, hepatitis, thrombocytopenia, rash, + fever, influenza-like symptoms, hypersensitivity reaction + i + Many drug-drug interactions +
- Monitoring - - Complete blood count (CBC), platelets and liver function tests. - Repeat measurements if: * baseline results are abnormal * client has symptoms of adverse reactions  Prior to starting RIF or RPT: need to carefully review all medications being taken by the patient with LTBI and ensure there is no contraindication to the use of that medication and RIF, RBT or RPT. - Monitoring + Complete blood count (CBC), platelets and liver function tests. + Repeat measurements if: + baseline results are abnormal + client has symptoms of adverse reactions  Prior to starting RIF + or RPT: need to carefully review all medications being taken by + the patient with LTBI and ensure there is no contraindication to + the use of that medication and RIF, RBT or RPT. +
- Comments - - Hepatitis risk increases with age and alcohol consumption. Rifampin monotherapy is associated with lower risk of hepatotoxicity compared to INH monotherapy for patients being treated for LTBI. Need to carefully review for possible drug-drug interactions prior to starting RIF, RBT or RPT and ensure there are no contraindications to these agents prior to using them for the treatment of LTBI. Comments + Hepatitis risk increases with age and alcohol consumption. + Rifampin monotherapy is associated with lower risk of + hepatotoxicity compared to INH monotherapy for patients being + treated for LTBI. Need to carefully review for possible + drug-drug interactions prior to starting RIF, RBT or RPT and + ensure there are no contraindications to these agents prior to + using them for the treatment of LTBI. +
- - +
+ - - + + - - + + - - + + - +
Adverse ReactionsSee adverse effects associated with isoniazid alone and a rifamycin alone (see above)Adverse Reactions + See adverse effects associated with isoniazid alone and a + rifamycin alone (see above) +
MonitoringComplete blood count (CBC), platelets and liver function tests. - Repeat measurements if: * baseline results are abnormal * client has symptoms of adverse reactions  Prior to starting RIF or RPT: need to carefully review all medications being taken by the patient with LTBI and ensure there is no contraindication to the use of that medication and RIF or RPT.Monitoring + Complete blood count (CBC), platelets and liver function tests. + Repeat measurements if: + baseline results are abnormal + client has symptoms of adverse reactions  Prior to starting RIF + or RPT: need to carefully review all medications being taken by + the patient with LTBI and ensure there is no contraindication to + the use of that medication and RIF or RPT. +
CommentsApproximately 4% of all patients using 3HP experience flu-like or other systemic drug reactions, with fever, headache, dizziness, nausea, muscle and bone pain, rash, itching, red eyes, or other symptoms. Approximately 5% of persons discontinue 3HP because of adverse events, including systemic drug reactions; these reactions typically occur after the first 3–4 doses, and begin approximately 4 hours after ingestion of medication.Comments + Approximately 4% of all patients using 3HP experience flu-like + or other systemic drug reactions, with fever, headache, + dizziness, nausea, muscle and bone pain, rash, itching, red + eyes, or other symptoms. Approximately 5% of persons discontinue + 3HP because of adverse events, including systemic drug + reactions; these reactions typically occur after the first 3–4 + doses, and begin approximately 4 hours after ingestion of + medication. +
+
+ +

+ * Hypersensitivity reaction to rifamycins (rifampin, rifabutin, + rifapentine): reactions may include a flu-like syndrome (e.g. fever, + chills, headaches, dizziness, musculoskeletal pain), thrombocytopenia, + shortness of breath or other signs and symptoms including wheezing, + acute bronchospasm, urticaria, petechiae, purpura, pruritus, + conjunctivitis, angioedema, hypotension or shock. If moderate to + severe reaction (e.g. thrombocytopenia, hypotension), hospitalization + or life-threatening event: Discontinue treatment. If mild reaction + (e.g. rash, dizziness, fever): Continue to monitor patient closely + with a low threshold for discontinuing treatment. A flu-like syndrome + appears to be the most common side effect profile leading to + discontinuation of the 3HP regimen. Rifabutin can rarely cause + uveitis. +

+ -

- * Hypersensitivity reaction to rifamycins (rifampin, rifabutin, rifapentine): reactions may include a flu-like syndrome (e.g. fever, chills, headaches, dizziness, musculoskeletal pain), thrombocytopenia, shortness of breath or other signs and symptoms including wheezing, acute bronchospasm, urticaria, petechiae, purpura, pruritus, conjunctivitis, angioedema, hypotension or shock. If moderate to severe reaction (e.g. thrombocytopenia, hypotension), hospitalization or life-threatening event: Discontinue treatment. If mild reaction (e.g. rash, dizziness, fever): Continue to monitor patient closely with a low threshold for discontinuing treatment. A flu-like syndrome appears to be the most common side effect profile leading to discontinuation of the 3HP regimen. Rifabutin can rarely cause uveitis. -

-
- - - - - - + + + diff --git a/app/src/main/assets/pages/3_treatment_of_latent_tb_infection_(ltbi)__b__monitoring_of_patients_on_treatment_for_ltbi.html b/app/src/main/assets/pages/3_treatment_of_latent_tb_infection_(ltbi)__b__monitoring_of_patients_on_treatment_for_ltbi.html index e773f62..2212261 100644 --- a/app/src/main/assets/pages/3_treatment_of_latent_tb_infection_(ltbi)__b__monitoring_of_patients_on_treatment_for_ltbi.html +++ b/app/src/main/assets/pages/3_treatment_of_latent_tb_infection_(ltbi)__b__monitoring_of_patients_on_treatment_for_ltbi.html @@ -19,7 +19,7 @@
- +

III. Treatment of Latent TB Infection (LTBI)

diff --git a/app/src/main/assets/pages/3_treatment_of_latent_tb_infection_(ltbi)__c__contacts_of_mdr_tb_cases.html b/app/src/main/assets/pages/3_treatment_of_latent_tb_infection_(ltbi)__c__contacts_of_mdr_tb_cases.html index fce91af..a864248 100644 --- a/app/src/main/assets/pages/3_treatment_of_latent_tb_infection_(ltbi)__c__contacts_of_mdr_tb_cases.html +++ b/app/src/main/assets/pages/3_treatment_of_latent_tb_infection_(ltbi)__c__contacts_of_mdr_tb_cases.html @@ -19,7 +19,7 @@
- +

III. Treatment of Latent TB Infection (LTBI)

diff --git a/app/src/main/assets/pages/4_laboratory_diagnosis_of_active_tuberculosis.html b/app/src/main/assets/pages/4_laboratory_diagnosis_of_active_tuberculosis.html index 15d7feb..f1295ee 100644 --- a/app/src/main/assets/pages/4_laboratory_diagnosis_of_active_tuberculosis.html +++ b/app/src/main/assets/pages/4_laboratory_diagnosis_of_active_tuberculosis.html @@ -19,7 +19,7 @@
- +

IV. Laboratory Diagnosis of Active Tuberculosis

diff --git a/app/src/main/assets/pages/4_laboratory_diagnosis_of_active_tuberculosis__a__considerations.html b/app/src/main/assets/pages/4_laboratory_diagnosis_of_active_tuberculosis__a__considerations.html index e2ee3c2..7362c47 100644 --- a/app/src/main/assets/pages/4_laboratory_diagnosis_of_active_tuberculosis__a__considerations.html +++ b/app/src/main/assets/pages/4_laboratory_diagnosis_of_active_tuberculosis__a__considerations.html @@ -19,7 +19,7 @@
- +

IV. Laboratory Diagnosis of Active Tuberculosis

diff --git a/app/src/main/assets/pages/4_laboratory_diagnosis_of_active_tuberculosis__b__selected_diagnostic_test_characteristics.html b/app/src/main/assets/pages/4_laboratory_diagnosis_of_active_tuberculosis__b__selected_diagnostic_test_characteristics.html index 6b372b0..e25c32b 100644 --- a/app/src/main/assets/pages/4_laboratory_diagnosis_of_active_tuberculosis__b__selected_diagnostic_test_characteristics.html +++ b/app/src/main/assets/pages/4_laboratory_diagnosis_of_active_tuberculosis__b__selected_diagnostic_test_characteristics.html @@ -19,7 +19,7 @@
- +

IV. Laboratory Diagnosis of Active Tuberculosis

diff --git a/app/src/main/assets/pages/4_laboratory_diagnosis_of_active_tuberculosis__c__laboratory_diagnosis_of_pulmonary_tuberculosis.html b/app/src/main/assets/pages/4_laboratory_diagnosis_of_active_tuberculosis__c__laboratory_diagnosis_of_pulmonary_tuberculosis.html index ea2ec0f..48b2c5c 100644 --- a/app/src/main/assets/pages/4_laboratory_diagnosis_of_active_tuberculosis__c__laboratory_diagnosis_of_pulmonary_tuberculosis.html +++ b/app/src/main/assets/pages/4_laboratory_diagnosis_of_active_tuberculosis__c__laboratory_diagnosis_of_pulmonary_tuberculosis.html @@ -15,66 +15,66 @@
-
-
-
-
- -
-

IV. Laboratory Diagnosis of Active Tuberculosis

+
+
+
+
+
-

Last Updated October 2025

+

IV. Laboratory Diagnosis of Active Tuberculosis

-
+

Last Updated October 2025

- -

Immunocompromised patients are less likely to have typical CXR findings (i.e., upper lobe infiltrates which may cavitate). A normal CXR does not rule out active pulmonary TB, especially in a person living with HIV.

- -

- A minimum of two AFB smears is generally recommended for persons with presumed pulmonary TB. The overall sensitivity of AFB smear for pulmonary TB is 50% to 70%, and the sensitivity is reduced among immunosuppressed and pediatric patients. -

- -

First morning sputum specimens have increased sensitivity - and at least one first morning specimen should be obtained.

- -

The sensitivity of ATS/IDSA/CDC endorsed NAATs for - smear-negative and smear-positive TB are approximately - 67% and 96% respectively. A negative NAAT performed on a - smear-negative sample does not rule out TB, whereas a - negative NAAT performed on a smear-positive sample usually indicates presence of non-tuberculous - mycobacteria.

- -

- For persons with presumed pulmonary TB who are unable to produce good quality sputum (defined as > 3 ml of sputum), consider obtaining induced sputum sample (using 3% NaCl aerosol) for smear, culture, and NAAT samples. -

- - medal - - Consider obtaining bronchoscopy with transbronchial biopsy for smear, culture, NAAT, and histopathology: ⌃ - -
-
    -
  • a) for patients with presumed pulmonary TB who are unable to produce a sputum and sputum induction fails to produce good quality samples;
    • -
  • b) when empiric TB treatment is unacceptable (e.g., high-risk for MDR TB);
    • -
  • and/or c) when bronchoscopy is indicated to investigate alternative diagnosis (e.g., lung cancer).
    • -
-
- -

- Bronchoscopy is an aerosol-generating procedure, and infection control and prevention measures for airborne pathogens should be observed. -

- -

Consider obtaining post-bronchoscopy sputum sample for - smear, culture, and NAAT

- -

- Children are more likely to have paucibacillary disease and are often unable to produce good quality - sputum specimens. However, clinicians should pursue microbiological TB diagnosis when feasible. Stool - for AFB culture and gastric aspirate when appropriately performed has a yield of > 50%. Instruct - patients to fast overnight prior to having the gastric aspirate performed. Commensal non-tuberculous - mycobacteria are present in the GI tract and a positive AFB smear of a gastric aspirate should be - interpreted with caution. (https://www.currytbcenter.ucsf.edu/products/view/pediatric-tuberculosis-guide-gastric-aspirate-ga-procedure). -

+
+
+ +

Immunocompromised patients are less likely to have typical CXR findings (i.e., upper lobe infiltrates which may cavitate). A normal CXR does not rule out active pulmonary TB, especially in a person living with HIV.

+ +

+ A minimum of two AFB smears is generally recommended for persons with presumed pulmonary TB. The overall sensitivity of AFB smear for pulmonary TB is 50% to 70%, and the sensitivity is reduced among immunosuppressed and pediatric patients. +

+ +

First morning sputum specimens have increased sensitivity + and at least one first morning specimen should be obtained.

+ +

The sensitivity of ATS/IDSA/CDC endorsed NAATs for + smear-negative and smear-positive TB are approximately + 67% and 96% respectively. A negative NAAT performed on a + smear-negative sample does not rule out TB, whereas a + negative NAAT performed on a smear-positive sample usually indicates presence of non-tuberculous + mycobacteria.

+ +

+ For persons with presumed pulmonary TB who are unable to produce good quality sputum (defined as > 3 ml of sputum), consider obtaining induced sputum sample (using 3% NaCl aerosol) for smear, culture, and NAAT samples. +

+ + medal + + Consider obtaining bronchoscopy with transbronchial biopsy for smear, culture, NAAT, and histopathology: ⌃ + +
+
    +
  • a) for patients with presumed pulmonary TB who are unable to produce a sputum and sputum induction fails to produce good quality samples;
    • +
  • b) when empiric TB treatment is unacceptable (e.g., high-risk for MDR TB);
    • +
  • and/or c) when bronchoscopy is indicated to investigate alternative diagnosis (e.g., lung cancer).
    • +
+
+ +

+ Bronchoscopy is an aerosol-generating procedure, and infection control and prevention measures for airborne pathogens should be observed. +

+ +

Consider obtaining post-bronchoscopy sputum sample for + smear, culture, and NAAT

+ +

+ Children are more likely to have paucibacillary disease and are often unable to produce good quality + sputum specimens. However, clinicians should pursue microbiological TB diagnosis when feasible. Stool + for AFB culture and gastric aspirate when appropriately performed has a yield of > 50%. Instruct + patients to fast overnight prior to having the gastric aspirate performed. Commensal non-tuberculous + mycobacteria are present in the GI tract and a positive AFB smear of a gastric aspirate should be + interpreted with caution. (https://www.currytbcenter.ucsf.edu/products/view/pediatric-tuberculosis-guide-gastric-aspirate-ga-procedure). +

diff --git a/app/src/main/assets/pages/4_laboratory_diagnosis_of_active_tuberculosis__d__laboratory_diagnosis_of_extrapulmary_tuberculosis.html b/app/src/main/assets/pages/4_laboratory_diagnosis_of_active_tuberculosis__d__laboratory_diagnosis_of_extrapulmary_tuberculosis.html index 21ad0a8..b4c624f 100644 --- a/app/src/main/assets/pages/4_laboratory_diagnosis_of_active_tuberculosis__d__laboratory_diagnosis_of_extrapulmary_tuberculosis.html +++ b/app/src/main/assets/pages/4_laboratory_diagnosis_of_active_tuberculosis__d__laboratory_diagnosis_of_extrapulmary_tuberculosis.html @@ -19,7 +19,7 @@
- +

IV. Laboratory Diagnosis of Active Tuberculosis

diff --git a/app/src/main/assets/pages/4_laboratory_diagnosis_of_active_tuberculosis__e__rapid_molecular_drug_susceptibility_tests_(dst).html b/app/src/main/assets/pages/4_laboratory_diagnosis_of_active_tuberculosis__e__rapid_molecular_drug_susceptibility_tests_(dst).html index 382e2e9..5662029 100644 --- a/app/src/main/assets/pages/4_laboratory_diagnosis_of_active_tuberculosis__e__rapid_molecular_drug_susceptibility_tests_(dst).html +++ b/app/src/main/assets/pages/4_laboratory_diagnosis_of_active_tuberculosis__e__rapid_molecular_drug_susceptibility_tests_(dst).html @@ -19,7 +19,7 @@
- +

IV. Laboratory Diagnosis of Active Tuberculosis

diff --git a/app/src/main/assets/pages/5_treatment_of_current_(active)_disease_therapy.html b/app/src/main/assets/pages/5_treatment_of_current_(active)_disease_therapy.html index 174c595..df02fb2 100644 --- a/app/src/main/assets/pages/5_treatment_of_current_(active)_disease_therapy.html +++ b/app/src/main/assets/pages/5_treatment_of_current_(active)_disease_therapy.html @@ -18,7 +18,7 @@
- +

V. Treatment of Current (Active) Disease Therapy

@@ -28,7 +28,7 @@

List of Subchapters

- +

List of charts

List of Figures

- +
diff --git a/app/src/main/assets/pages/5_treatment_of_current_(active)_disease_therapy__b__standard_therapy_for_current_(active)_disease.html b/app/src/main/assets/pages/5_treatment_of_current_(active)_disease_therapy__b__standard_therapy_for_current_(active)_disease.html index f93f968..411df47 100644 --- a/app/src/main/assets/pages/5_treatment_of_current_(active)_disease_therapy__b__standard_therapy_for_current_(active)_disease.html +++ b/app/src/main/assets/pages/5_treatment_of_current_(active)_disease_therapy__b__standard_therapy_for_current_(active)_disease.html @@ -17,7 +17,7 @@
- +

V. Treatment of Current (Active) Disease Therapy

@@ -29,12 +29,12 @@
  1. Initiate therapy with a 4-drug regimen as shown in (Table 7 )⌃ -
    -
      -
    • - Any patient who is started on treatment for suspected or proven active TB disease (even while still in the hospital) should be reported to local public health authorities at the time treatment is started. +
      +
        +
      • + Any patient who is started on treatment for suspected or proven active TB disease (even while still in the hospital) should be reported to local public health authorities at the time treatment is started.
      • Therapy consists of an initiation phase and a continuation phase.
        • -
      • The initiation phase for presumed on confirmed drug-susceptible active TB disease generally consists of a 4-drug regimen given daily or 5 times per week per DOT. An option for twice weekly therapy by DOT after the initial 2 weeks of daily therapy (“Denver regimen”) is not recommended by the Georgia TB Program for any persons diagnosed with active TB disease and should never be used for persons living with HIV infection, cavitary pulmonary TB, disseminated TB, vertebral TB or for patients who have co-morbid medical conditions such as diabetes mellitus, end-stage renal disease, or liver disease.
        • +
      • The initiation phase for presumed or confirmed drug-susceptible active TB disease generally consists of a 4-drug regimen given daily or 5 times per week per DOT. An option for twice weekly therapy by DOT after the initial 2 weeks of daily therapy (“Denver regimen”) is not recommended by the Georgia TB Program for any persons diagnosed with active TB disease and should never be used for persons living with HIV infection, cavitary pulmonary TB, disseminated TB, vertebral TB or for patients who have co-morbid medical conditions such as diabetes mellitus, end-stage renal disease, or liver disease.
      • The initiation phase is followed by a continuation phase. For drug susceptible disease, this can consist of daily, 5 times per week or thrice weekly by DOT (see Table 7 ). For patients with HIV co-infection, in @@ -44,69 +44,69 @@ weekly by DOT. In general, daily therapy is preferred throughout for patients with HIV co-infection or other immune-compromising conditions. See Figure 1.
        • -
      • See Tables 8 and 9, 10, 11, 12 for dosing recommendations for adults and children.
        • - -
      -
      -
      • -
    • For patients with pulmonary TB, sputum specimens should be obtained at a minimum on a monthly basis until two consecutive specimens are culture negative (some obtain monthly specimens throughout the course of therapy). As discussed above, the 2-month culture is a critical data-point. +
    • See Tables 8 and 9 for dosing recommendations for adults and children.
      • +
    +
    +
    2. +
  2. For patients with pulmonary TB, sputum specimens should be obtained at a minimum on a monthly basis until two consecutive specimens are culture negative (some obtain monthly specimens throughout the course of therapy). As discussed above, the 2-month culture is a critical data-point. +
    3. -
  3. Twice-weekly therapy is not recommended for use in the continuation phase by us and is contraindicated for - treat- ment of persons living with HIV. -
    4. +
  4. Twice-weekly therapy is not recommended for use in the continuation phase by us and is contraindicated for + treat- ment of persons living with HIV. +
    5. -
  5. Rifampin (RIF) has many drug-drug interactions and may accelerate clearance of drugs metabolized by the liver - including methadone, coumadin, glucocorticoids, estrogens, oral hypoglycemic agents, anticonvulsants, - fluconazole, voriconazole, itraconazole, cyclosporin, and protease inhibitors. Rifabutin can be used as a - first - line drug in place of rifampin for patients who are receiving medications, especially antiretroviral drugs, - that - have unacceptable interactions with rifampin. -
      -
    • Women taking RIF (or rifabutin) should use a barrier birth control method (and not rely on hormone - contraceptives alone). -
      • -
    +
  6. Rifampin (RIF) has many drug-drug interactions and may accelerate clearance of drugs metabolized by the liver + including methadone, coumadin, glucocorticoids, estrogens, oral hypoglycemic agents, anticonvulsants, + fluconazole, voriconazole, itraconazole, cyclosporin, and protease inhibitors. Rifabutin can be used as a + first + line drug in place of rifampin for patients who are receiving medications, especially antiretroviral drugs, + that + have unacceptable interactions with rifampin. +
      +
    • Women taking RIF (or rifabutin) should use a barrier birth control method (and not rely on hormone + contraceptives alone).
      • +
    +
    7. -
  7. Dose-counting: Although TB treatment regimens are generally described in terms of “months” of treatment, it - is - important that each patient receives an adequate number of doses. Thus, treatment completion is defined by - number of doses actually taken as well as duration of treatment. The number of doses required for each - regimen - is listed in Table 7 . +
  8. Dose-counting: Although TB treatment regimens are generally described in terms of “months” of treatment, it + is + important that each patient receives an adequate number of doses. Thus, treatment completion is defined by + number of doses actually taken as well as duration of treatment. The number of doses required for each + regimen + is listed in Table 7 . +
    9. +
  9. Follow-up after completion of therapy is generally not needed for patients who have had a satisfactory and prompt bacteriologic response and who have completed observed therapy with a 6- or 9-month INH- and RIF-containing regimen for drug-susceptible TB. Patients should be informed to seek prompt medical evaluation if symptoms reappear.
    10. +
+Precautions⌃ +
+
    +
  • Daily intake of alcohol increases the risk of hepatitis among patients taking INH.
    • +
  • Never add a single drug to a failing regimen.
    • +
  • Directly observed therapy (DOT) is the standard of care for administering treatment of active TB disease, and such treatment should be supervised and coordinated by the local health department. For + any patient on self-administered therapy, dispense only a 1-month supply of medicine at a time.
    • -
  • Follow-up after completion of therapy is generally not needed for patients who have had a satisfactory and prompt bacteriologic response and who have completed observed therapy with a 6- or 9-month INH- and RIF-containing regimen for drug-susceptible TB. Patients should be informed to seek prompt medical evaluation if symptoms reappear.
    • - - Precautions⌃ -
    -
      -
    • Daily intake of alcohol increases the risk of hepatitis among patients taking INH.
      • -
    • Never add a single drug to a failing regimen.
      • -
    • Directly observed therapy (DOT) is the standard of care for administering treatment of active TB disease, and such treatment should be supervised and coordinated by the local health department. For - any patient on self-administered therapy, dispense only a 1-month supply of medicine at a time. -
      • -
    -
    - 4-month Treatment Regimens for Drug-Susceptible TB⌃ -
    -
      -
    • - A 4-month treatment regimen of rifapentine, moxifloxacin, isoniazid, and pyrazinamide was found to be non-inferior compared to the standard 6-month TB treatment regimen for active drug-susceptible pulmonary TB (N Engl J Med 2021; 384:1705-1718). -
      • -
    • - This study provides evidence that in the future it may be possible to use shorter TB treatment regimens. -
      • -
    • - This 4-month regimen is not currently recommended by the Georgia Department of Public Health TB Program. -
      • -
    • - CDC has released interim guidelines on the use of this new 4-month regimen (http://dx.doi.org/10.15585/mmwr.mm7108a1); further infrastructure development for fluoroquinolone susceptibility testing of M. tuberculosis isolates is also needed to implement this new treatment regimen in Georgia and other communities in the U.S. -
      • -
    -
    +
+
+4-month Treatment Regimens for Drug-Susceptible TB⌃ +
+
    +
  • + A 4-month treatment regimen of rifapentine, moxifloxacin, isoniazid, and pyrazinamide was found to be non-inferior compared to the standard 6-month TB treatment regimen for active drug-susceptible pulmonary TB (N Engl J Med 2021; 384:1705-1718). +
    • +
  • + This study provides evidence that in the future it may be possible to use shorter TB treatment regimens. +
    • +
  • + This 4-month regimen is not currently recommended by the Georgia Department of Public Health TB Program. +
    • +
  • + CDC has released interim guidelines on the use of this new 4-month regimen (http://dx.doi.org/10.15585/mmwr.mm7108a1); further infrastructure development for fluoroquinolone susceptibility testing of M. tuberculosis isolates is also needed to implement this new treatment regimen in Georgia and other communities in the U.S. +
    • +
+
diff --git a/app/src/main/assets/pages/5_treatment_of_current_(active)_disease_therapy__c__special_clinical_situations.html b/app/src/main/assets/pages/5_treatment_of_current_(active)_disease_therapy__c__special_clinical_situations.html index e5855f9..71c0bb9 100644 --- a/app/src/main/assets/pages/5_treatment_of_current_(active)_disease_therapy__c__special_clinical_situations.html +++ b/app/src/main/assets/pages/5_treatment_of_current_(active)_disease_therapy__c__special_clinical_situations.html @@ -18,7 +18,7 @@
- +

V. Treatment of Current (Active) Disease Therapy

@@ -28,11 +28,11 @@
  1. -

    Dosing for TB medications in adults with renal impairment is shown in Table 13 .

    +

    Dosing for TB medications in adults with renal impairment is shown in Table 10 .

  2. Therapy for TB in clinical situations for which standard TB therapy may not be tolerated or may be - ineffective is shown in Table 14 and Table 15 .

    3. + ineffective is shown in Table 11 and Table 12 .

  3. There is a new 4-month TB treatment regimen for the treatment of drug-susceptible active TB disease as noted above. At this time, the Georgia Department of Public Health does not have the infrastructure for routine implementation of this 4-month treatment regimen.
  4. Current obstacles to implementation include:⌃ @@ -47,122 +47,104 @@
-

Table 7: Recommended Regimens for Treatment of Adults and Children with Drug Susceptible TB Pulmonary TB

+

Table 7: Recommended Regimens for Treatment of Adults and Children with Drug Susceptible Pulmonary TB

Figure 1. Factors to be considered in deciding to initiate treatment empirically for active tuberculosis (TB) (prior @@ -193,201 +175,206 @@

Table 8: First-Line TB Drugs: Fixed/
    • -
    • -
    • +
    • +

    • -
    - - - - - - - - - - - - - - - - - -
    FrequencyDailyThrice-Weekly
    Adult Dose based on body weight in kilograms (kg)*300 mg900 mg
    Adverse Reactions -
      -
    • Gastrointestinal (GI) upset
      • -
    • Liver enzyme elevation
      • -
    • Hepatitis
      • -
    • Mild effects on central nervous
      • -
    • Drug interactions
      • -
    -
    -
    - -
    - - - - - - - - - - - - - - - - - -
    FrequencyDailyThrice-Weekly
    Adult Dose based on body weight in kilograms (kg)*600 mg600 mg
    Adverse Reactions -
      -
    • Orange discoloration of body fluids and secretions
      • -
    • Drug interactions
      • -
    • GI upset
      • -
    • Hepatitis
      • -
    • Bleeding problems
      • -
    • Influenze-like symptoms
      • -
    • Rash
      • -
    • Uveitis (rifabutin only)
      • -
    -
    -
    - -
    - - - - - - - - - - - - - - - - - -
    FrequencyDailyThrice-Weekly
    Adult Dose based on body weight in kilograms (kg)*300 mgNot recommended
    Adverse Reactions -
      -
    • Orange discoloration of body fluids and secretions
      • -
    • Drug interactions
      • -
    • GI upset
      • -
    • Hepatitis
      • -
    • Bleeding problems
      • -
    • Influenze-like symptoms
      • -
    • Rash
      • -
    • Uveitis (rifabutin only)
      • -
    -
    -
    - -
    - - - - - - - - - - - - - - - - - - - - - - - - - -
    FrequencyDailyThrice-Weekly
    Adult Dose based on body weight in kilograms (kg)*40-55 kg: 1000 mg40-55 kg: 1500 mg
    56-75 kg: 2500 mg56-75 kg: 1500 mg
    76+ kg: 3000 mg76+ kg: 4000 mg
    Adverse Reactions -
      -
    • Orange discoloration of body fluids and secretions
      • -
    • Drug interactions
      • -
    • GI upset
      • -
    • Hepatitis
      • -
    • Bleeding problems
      • -
    • Influenze-like symptoms
      • -
    • Rash
      • -
    • Uveitis (rifabutin only)
      • -
    -
    -
    - -
    - - - - - - - - - - - - - - - - - - - - - - - - - -
    FrequencyDailyThrice-Weekly
    Adult Dose based on body weight in kilograms (kg)*40-55 kg: 800 mg40-55 kg: 1200 mg
    56-75 kg: 1200 mg56-75 kg: 2000 mg
    76+ kg: 1600 mg76+ kg: 2400 mg
    Adverse Reactions -
      -
    • Optic neuritis
      • -
    -
    -
    +
    + + + + + + + + + + + + + + + + + +
    FrequencyDailyThrice-Weekly
    Adult Dose based on body weight in kilograms (kg) i300 mg900 mg
    Adverse Reactions +
      +
    • Gastrointestinal (GI) upset
      • +
    • Liver enzyme elevation
      • +
    • Hepatitis
      • +
    • Mild effects on central nervous
      • +
    • Drug interactions
      • +
    +
    +
    -

    *Formula used to convert pounds to kilograms: Divide pounds by 2.2 to get kilograms.

    -

    Example: Patient weighs 154 pounds ÷ 2.2 = 70 kilograms.

    -

    ** Calculate pyrazinamide and ethambutol doses using actual body weight. Pyrazinamide and ethambutol dosage - adjustment is needed in patients with estimated creatinine clearance less than 50 ml/min or those with - end-stage renal disease on dialysis.

    -

    NOTE: Refer to current drug reference or drug package insert for a complete list of adverse drug reactions - and drug interactions.

    +
    + + + + + + + + + + + + + + + + + +
    FrequencyDailyThrice-Weekly
    Adult Dose based on body weight in kilograms (kg) i600 mg600 mg
    Adverse Reactions +
      +
    • Orange discoloration of body fluids and secretions
      • +
    • Drug interactions
      • +
    • GI upset
      • +
    • Hepatitis
      • +
    • Bleeding problems
      • +
    • Influenze-like symptoms
      • +
    • Rash
      • +
    • Uveitis (rifabutin only)
      • +
    +
    +
    +
    + + + + + + + + + + + + + + + + + +
    FrequencyDailyThrice-Weekly
    Adult Dose based on body weight in kilograms (kg) i300 mgNot recommended
    Adverse Reactions +
      +
    • Orange discoloration of body fluids and secretions
      • +
    • Drug interactions
      • +
    • GI upset
      • +
    • Hepatitis
      • +
    • Bleeding problems
      • +
    • Influenze-like symptoms
      • +
    • Rash
      • +
    • Uveitis (rifabutin only)
      • +
    +
    +
    +
    + + + + + + + + + + + + + + + + + + + + + + + + + +
    FrequencyDailyThrice-Weekly
    Adult Dose based on body weight in kilograms (kg) i40-55 kg: 1000 mg40-55 kg: 1500 mg
    56-75 kg: 2500 mg56-75 kg: 1500 mg
    76+ kg: 3000 mg76+ kg: 4000 mg
    Adverse Reactions +
      +
    • Orange discoloration of body fluids and secretions
      • +
    • Drug interactions
      • +
    • GI upset
      • +
    • Hepatitis
      • +
    • Bleeding problems
      • +
    • Influenze-like symptoms
      • +
    • Rash
      • +
    • Uveitis (rifabutin only)
      • +
    +
    -
    -

    Table 9: Pediatric Dosage - Isoniazid in Children (birth to 15 years)

    +
    + + + + + + + + + + + + + + + + + + + + + + + + + +
    FrequencyDailyThrice-Weekly
    Adult Dose based on body weight in kilograms (kg) i40-55 kg: 800 mg40-55 kg: 1200 mg
    56-75 kg: 1200 mg56-75 kg: 2000 mg
    76+ kg: 1600 mg76+ kg: 2400 mg
    Adverse Reactions +
      +
    • Optic neuritis
      • +
    +
    +
    -
    +
      +
    1. Calculate pyrazinamide and ethambutol doses using actual body weight. Pyrazinamide and ethambutol dosage adjustment is needed in patients with estimated creatinine clearance less than 50 ml/min or those with end-stage renal disease on dialysis.
      2. +
    + +

    Additional Note: Refer to current drug reference or drug package insert for a complete list of adverse drug reactions and drug interactions.

    - +
    + +

    Table 9: Pediatric Dosage in Children (Birth to 15 Years)

    +
    +
    +
      +
      • +
      • +
      • +
      • +
    +
    + +
    - - - + + + @@ -494,32 +481,27 @@

    Table 9: Pediatric Dosage - Isoniazid

    Child's Weight (lbs)Child's Weight (kg)Daily Dose (mg) 10-15 mg/kg POChild's Weight (lbs)Child's Weight (kg)Daily Dose (mg) 10-15 mg/kg PO
    - +

    NOTE: Isoniazid tablets come in 50 mg, 100mg, 300 mg sizes and can be crushed for oral administration. Isoniazid tablets are also scored.

    Isoniazid Syrup (50mg/5ml) should not be refrigerated. It contains sorbitol and will cause diarrhea. It should be used only when crushed tablets cannot accommodate the situation. (keep at room temperature).

    -
    -
    - - -

    Table 10. Pediatric Dosages - Rifampin in Children (birth to 15 years)

    -
    -
    - - + +
    +
    +
    + - - - - + + + + - + @@ -537,180 +519,163 @@

    Table 10. Pediatric Dosages - Rifamp

    -
    Child's Weight (lbs)Child's Weight (kg)Dose (mg) 10-20 mg/kgChild's Weight (lbs)Child's Weight (kg)Daily Dose (mg) 10-20 mg/kg
    15 - 327 - 14.5 7 - 14.5 150 mg
    30 + 600 mg
    + +
    -
    - - -

    Table 11: Pediatric Dosages - Ethambutol in Children (birth to 15 years)

    -
    -
    - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
    Child’s Weight (lbs)Child’s Weight (kg)Daily Dose (mg) 15 – 25 mg/kg
    11 – 155 – 7100 mg
    16 – 318 – 14200 mg
    32 – 4415 – 20300 mg
    45 – 5521 – 25400 mg
    56 – 6726 – 30.5500 mg
    68 – 7631 – 34.5600 mg
    77 – 8735 – 39.5700 mg
    88 – 12140 – 55800 mg
    122 – 16556 – 751200 mg
    166 +76 +1600 mg
    -

    - The maximum recommendation for ethambutol is 1 g daily. -

    + +
    +
    + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
    Child’s Weight (lbs)Child’s Weight (kg)Daily Dose (mg) 15 – 25 mg/kg
    11 – 155 – 7100 mg
    16 – 318 – 14200 mg
    32 – 4415 – 20300 mg
    45 – 5521 – 25400 mg
    56 – 6726 – 30.5500 mg
    68 – 7631 – 34.5600 mg
    77 – 8735 – 39.5700 mg
    88 – 12140 – 55800 mg
    122 – 16556 – 751200 mg
    166 +76 +1600 mg
    +

    Additional Notes:
    + The maximum recommendation for ethambutol is 1g daily. +

    +
    -
    - - -

    Table 12: Pediatric Dosages - Pyrazinamide in Children (birth to 15 years)

    -
    -
    - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - +
    +
    +
    Child's Weight (lbs)Child's Weight (kg)Daily Dose (mg) 30-40 mg/kg PO
    13 - 236 - 10.5250 mg
    24 - 2611 - 12250 mg
    27 - 3112.5 - 14500 mg
    32 - 4114.5 - 18.5500 mg
    42 - 4719.0 - 21.5750 mg
    48 - 5422.0 - 24.5750 mg
    55 – 6325 – 28.51000 mg
    64 – 6729 – 30.51000 mg
    68 – 8031 – 36.51250 mg
    + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + - - - - - - - - - - - - - - - - - - - -
    Child's Weight (lbs)Child's Weight (kg)Daily Dose (mg) 30-40 mg/kg
    13 - 236 - 10.5250 mg
    24 - 2611 - 12250 mg
    27 - 3112.5 - 14500 mg
    32 - 4114.5 - 18.5500 mg
    42 - 4719.0 - 21.5750 mg
    81 – 9337 – 42.51500 mg
    94 – 10643 – 48.51750 mg
    107 +49 +2000 mg
    + + + 48 - 54 + 22.0 - 24.5 + 750 mg + + + 55 – 63 + 25 – 28.5 + 1000 mg + + + 64 – 67 + 29 – 30.5 + 1000 mg + + + 68 – 80 + 31 – 36.5 + 1250 mg + + + 81 – 93 + 37 – 42.5 + 1500 mg + + + 94 – 106 + 43 – 48.5 + 1750 mg + + + 107 + + 49 + + 2000 mg + + +
    -

    Table 13: Antituberculosis Antibiotics in Adult Patients with Renal Impairment

    +

    Table 10: Antituberculosis Antibiotics in Adult Patients with Renal Impairment

    NOTE: Drug adjustments are based on the creatinine clearance (CrCl) which can be estimated as follows:

    [(140-age in yrs)(Ideal body weight in kg) for men (x 0l85 for women)] / [(72) (serum creatinine, mg/dL)]

    Ideal body weight for men: 50 kg + 2.3 kg per inch over 5 feet

    Ideal body weight for women: 45.5 kg + 2.3 kg per inch over 5 feet

    + id="table_10_antituberculosis_antibiotics_in_adult_patients_with_renal_impairment">
      • @@ -724,6 +689,9 @@

      Table 13: Antituberculosis Antibioti

    + +

    Important Note i

    +

    NOTE: Drug adjustments are based on the creatinine clearance (CrCl) which can be estimated as follows:
    [(140-age in yrs)(Ideal body weight in kg) for men (x 0l85 for women)] / [(72) (serum creatinine, mg/dL)] @@ -956,10 +924,10 @@

    Table 13: Antituberculosis Antibioti

    -

    Table 14: Antituberculosis medications which may be used for patients who have contraindications to or intolerance of first line agents or who require IV therapy during acute or critical illness

    +

    Table 11: Antituberculosis medications which may be used for patients who have contraindications to or intolerance of first line agents or who require IV therapy during acute or critical illness

    + id="table_11_antituberculosis_medications_which_may_be_used_for_patients_who_have_contraindications_to_or_intolerance">
      @@ -979,15 +947,21 @@

      Table 14: Antituberculosis medicatio - + - + + + + + @@ -1004,13 +978,19 @@

      Table 14: Antituberculosis medicatio

      Dosing (A for adults, C for children)Dosing - A: 750 mg daily
      - C: 15 – 20 mg/kg daily
      - Max dose: 750 mg + Adults
      + 750 mg

      + Children
      + 15 - 20 mg

      + Max dose
      750 mg
      Adverse ReactionsFrequencyDaily
      Adverse Reactions GI upset, dizziness, hypersensitivity, Headaches, QT prolongation, tendon rupture (rare), arthralgia, increased risk for aortic dissection/rupture, hypo/hyperglycemia
      - + + + + + + + + + + +

      2b

      +
      Dosing (A for adults, C for children)Dosing - A: 10-15 mg/kg
      - C: No established dose
      - Max dose: 400 mg + Adults
      + 10 - 15 mg/kg

      + Children
      + No established dose

      + Max dose
      450 mg
      FrequencyDaily
      Adverse Reactions @@ -1030,22 +1010,28 @@

      Table 14: Antituberculosis medicatio

      Dosing (A for adults, C for children) - A: 600 mg (once daily)
      - C: - Children < 12 years: -
        -
      • 5 – 10 kg: 15 mg/kg once daily
        • -
      • 10 – 23 kg: 12 mg/kg once daily
        • -
      • >23 kg: 10 mg/kg once daily
        • -
      - Children ≥12 years: + Adults
      + 600 mg

      + + Children < 12 years
        -
      • 10 mg/kg once daily
        • +
      • 5 – 10 kg: 15 mg/kg
        • +
      • 10 – 23 kg: 12 mg/kg
        • +
      • >23 kg: 10 mg/kg
      - Max dose: 600 mg + + Childrenl ≥ 12 years
      + 10 mg/kg

      + + Max dose
      600 mg
      FrequencyDaily
      Adverse Reactions @@ -1059,16 +1045,19 @@

      Table 14: Antituberculosis medicatio
      - - + + + + + + +

      2a

      +
      Dosing (A for adults, C for children)
      Dosing - A: 10 to 15 mg/kg/day
      - 5-7 days per week or 3 times per week

      - - C: 15 to 30 mg/kg/day (max dose 1 gram)
      - 5-7 days per week or 3 times per week + Adults
      + 10 to 15 mg/kg/day

      + Children
      + 15 to 30 mg/kg/day (max dose 1 gram)
      Frequency5-7 days per week or 3 times per week
      Adverse Reactions @@ -1081,11 +1070,11 @@

      Table 14: Antituberculosis medicatio -

      Table 15: Clinical Situations for which standard therapy cannot be given or is not well- tolerated or may not be effective: Potential Alternative Regimens (Dosing and/or Drugs)

      +

      Table 12: Clinical Situations for which Standard Therapy cannot be given or is not well-tolerated or may not be effective: Potential Alternative Regimens (Dosing and/or Drugs)

      - + id="table_12_clinical_situations_for_which_standard_therapy_cannot_be_given_or_is_not_well_tolerated"> + + +
      +
      + + + + + + + +
      + +
      +
      + + + + + + + + + + + + + + +
      Concerns RaisedPoor gut medication absorption
      Regimen +
        +
      • IV rifampin ≥ 10 mg/kg daily
        • +
      • PO pyrazinamide
        • +
      • PO ethambutol
        • +
      + Consider adding at least two of the following agents. +
        +
      • IV isoniazid i
        • +
      • IV levofloxacin or moxifloxacin
        • +
      • IV linezolid i
        • +
      • IV amikacin i
        • +
      +
      Comments +
        +
      • Oral medications are generally poorly bioavailable among critically ill patients.
        • +
      • Patients receiving sedation are unable to report isoniazid or linezolid-induced neuropathies nor aminoglycoside- induced otovestibular toxicity
        • +
      +
      +
      + +
      + + + + + + + + + + + + + + + +
      Concerns RaisedRapidly progressive and often fatal. High plasma levels needed to achieve adequate CNS penetration. + High index of suspicion necessary; microbiological diagnostic tests have low yield.
      Regimen +
        +
      • IV rifampin ≥ 10 mg/kg daily
        • +
      • PO or IV i isoniazid UD
        • +
      • PO pyrazinamide UD PO ethambutol UD (adults)
        • +
      • PO ethionamide (children)
        • +
      +

      Consider adding IV levofloxacin or moxifloxacin UD in lieu of ethambutol, especially if there is concern for isoniazid-resistant TB.

      +
      CommentsRifampin has poor CNS penetration but is an essential drug for meningeal TB treatment. Isoniazid, + pyrazinamide, levofloxacin, and moxifloxacin have excellent CNS penetration. +

      Ethambutol has poor CNS penetration. Early use of fluoroquinolones has been associated with + improved outcomes among patients with isoniazid-resistant meningeal TB

      +
      + +
      + + + + + + + + + + + + + + + +
      Concerns RaisedIncreased risk for pyrazinamide-induced hepatotoxicity
      RegimenCan consider rifampin, isoniazid, and ethambutol without pyrazinamide when drug-susceptibility is + known and/or patient has low burden of disease
      Comments3-drug regimens may increase risk of failure or acquired drug-resistance.
      +
      + +
      + + + + + + + + + + + + + + + +
      Concerns RaisedDisseminated TB is associated with gut edema which decreases po medication bioavailability
      RegimenStandard 4-drug regimen Consider increasing po Rifampin dose (15 to 20 mg/kg daily, minimum 600 mg) + Consider IV rifampin and IV isoniazid i for inpatients.
      CommentsConsider obtaining TB drug levels in ensure po dosing achieves at least minimum levels
      +
      + +
      + + + + + + + + + + + + + + + +
      Concerns RaisedTube feeds may decrease TB drug bioavailability
      RegimenNo change in standard TB regimen
      CommentsHold tube feeds ≤2 hours prior and ≥1 hour after TB drug intake. Longer intervals are needed if quinolone- containing regimens are given with divalent-cation containing tube feeds
      +
      + +
      + + + + + + + + + + + + + + + +
      Concerns RaisedConsider limiting number of hepatotoxic drugs for patients with baseline ALT>3x UNL and/or advanced + liver disease. + Order of hepatotoxicity: PZA>INH>RIF
      Regimen +
        +
      • RIF/INH/EMB +/- FQN
        • +
      • RIF/EMB/FQN +/- LZD or AG
        • +
      • EMB/FQN +/- LZD or AG
        • +
      +
      Comments + Consider baseline liver enzyme elevation could be due to hepatic TB

      + 3-drug regimens may increase risk of failure or acquired drug-resistance. +
      +
      + +
      + + + + + + + + + + + + + + + +
      Concerns RaisedTB drug-induced hepatotoxicity + Stop TB drugs if ALT>3x UNL and patient symptomatic or ALT >5x UNL regardless of symptoms
      RegimenSequential re-introduction of TB drugs once ALT <2x UNL.
      + (1) Rifamycin x 5-7 days
      + (2) Isoniazid x 5-7 days
      + (3) Ethambutol x 5-7 days
      + (4) Need and choice of 4th agent depends on burden of disease and drug-susceptibility pattern. +
      CommentsPyrazinamide is often the culprit and effective regimens can be designed without this drug. + Rifamycins are the drugs most important for sterilizing activity (i.e., cure) in TB treatment. + Consider adding a 4th drug if patient has high burden of disease.
      +
      +

      Abbreviations: UD, usual dose; UNL, upper normal limit.

      -

      TABLE 15 NOTES

      -

      1-Some of these recommendations differ or are not addressed by 2016 ATS/CDC/IDSA drug-susceptible TB - guidelines. Drug-susceptibility testing for second-line drugs should be requested if these agents are - used.

      -

      2-Limited availability

      -

      3-Associated with peripheral neuropathy. Add B6 ≥50 mg/daily

      -

      4-Associated with irreversible peripheral and optic neuritis. Add B6 ≥ 50 mg/daily

      -

      5-Associated with otovestibular toxicity

      -

      6-These recommendations are meant for patients with known drug-susceptible TB or at low risk for drug- - resistant TB

      + +

      Additional Notes:
      + These recommendations are meant for patients with known drug-susceptible TB or at low risk for drug- resistant TB

      +
      @@ -1200,4 +1379,5 @@

      Table 15: Clinical Situations for wh + diff --git a/app/src/main/assets/pages/5_treatment_of_current_(active)_disease_therapy__d__drug_resistance.html b/app/src/main/assets/pages/5_treatment_of_current_(active)_disease_therapy__d__drug_resistance.html index f47eeb5..7c6a82d 100644 --- a/app/src/main/assets/pages/5_treatment_of_current_(active)_disease_therapy__d__drug_resistance.html +++ b/app/src/main/assets/pages/5_treatment_of_current_(active)_disease_therapy__d__drug_resistance.html @@ -20,7 +20,7 @@
      - +

      V. Treatment of Current (Active) Disease Therapy

      diff --git a/app/src/main/assets/pages/5_treatment_of_current_(active)_disease_therapy__e__monitoring_patients_on_therapy_for_response_and_adverse_events.html b/app/src/main/assets/pages/5_treatment_of_current_(active)_disease_therapy__e__monitoring_patients_on_therapy_for_response_and_adverse_events.html index 26610b6..ad474ea 100644 --- a/app/src/main/assets/pages/5_treatment_of_current_(active)_disease_therapy__e__monitoring_patients_on_therapy_for_response_and_adverse_events.html +++ b/app/src/main/assets/pages/5_treatment_of_current_(active)_disease_therapy__e__monitoring_patients_on_therapy_for_response_and_adverse_events.html @@ -38,7 +38,7 @@
    • Patients with cavitary pulmonary TB who have a positive 2-month sputum culture are at increased risk for relapse if treated with only 6 months of therapy for drug-susceptible TB. If the 2-month culture remains positive or if symptoms do not resolve, request repeat drug susceptibility testing to evaluate for acquired drug resistance. Additionally, review information - related to treatment adherence. For any patient receiving self-administered therapy (this should be very rare as DOT is our standard of care) who has a positive 2-month culture, DOT should be initiated. +related to treatment adherence. For any patient receiving self-administered therapy (this should be very rare as DOT is our standard of care) who has a positive 2-month culture, DOT should be initiated.
    • For patients with drug-susceptible active TB disease who have positive 2-month culture and have cavitary disease on their initial CXR, the continuation phase should be increased to 7 months so that they receive a total of 9 months of therapy. diff --git a/app/src/main/assets/pages/5_treatment_of_current_(active)_disease_therapy__f__tb_and_hiv.html b/app/src/main/assets/pages/5_treatment_of_current_(active)_disease_therapy__f__tb_and_hiv.html index fccf6e6..56fa619 100644 --- a/app/src/main/assets/pages/5_treatment_of_current_(active)_disease_therapy__f__tb_and_hiv.html +++ b/app/src/main/assets/pages/5_treatment_of_current_(active)_disease_therapy__f__tb_and_hiv.html @@ -11,276 +11,290 @@ - -
      -
      -
      -
      -
      - -
      -

      V. Treatment of Current (Active) Disease Therapy

      +
      +
      +
      +
      +
      +
      -

      Last Updated October 2025

      +

      V. Treatment of Current (Active) Disease Therapy

      -
      -
      -

      - Treatment of persons living with HIV with active TB disease should be carried out in consultation with a - physician who has experience in the use of rifamycin drugs and antiretroviral agents. - Recommendations on the treatment of TB in combination with antiretroviral therapy continue to evolve, and it - is important to check for updated guidelines: - https://clinicalinfo.hiv.gov/en/guidelines and - - https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-arv/tuberculosishiv-coinfection?view=full - -

      - Antiretroviral therapy (ART)⌃ -
      -
        -
      • - Improves outcomes for persons living with HIV and decreases HIV-related mortality as well as risk of - relapse. Persons living with HIV in the United States with active TB disease commonly have advanced - HIV/AIDS with low CD4 counts and high plasma HIV RNA levels; all patients with TB who have HIV - co-infection should receive treatment for HIV with ART. -
        • -
      +

      Last Updated October 2025

      - Timing of ART⌃ -
      -
        -
      • - Multiple studies have demonstrated the benefits of ART initiation among persons living with HIV - during TB treatment, including a reduction in mortality. -
        • -
      • - However, the use of ART among persons living with HIV with active TB disease is complicated by - overlapping toxicity profiles of some antituberculosis and antiretroviral drugs; complex drug-drug - interactions; and the occurrence of “paradoxical” reactions or immune reconstitution inflammatory - syndrome (IRIS). -
        • -
      -
      - All persons living with HIV who are diagnosed with active +
      +
      +

      + Treatment of persons living with HIV with active TB disease should be carried out in consultation with a + physician who has experience in the use of rifamycin drugs and antiretroviral agents. + Recommendations on the treatment of TB in combination with antiretroviral therapy continue to evolve, and it + is important to check for updated guidelines: + https://clinicalinfo.hiv.gov/en/guidelines and + + https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-arv/tuberculosishiv-coinfection?view=full + +

      + Antiretroviral therapy (ART)⌃ +
      +
        +
      • + Improves outcomes for persons living with HIV and decreases HIV-related mortality as well as risk of + relapse. Persons living with HIV in the United States with active TB disease commonly have advanced + HIV/AIDS with low CD4 counts and high plasma HIV RNA levels; all patients with TB who have HIV + co-infection should receive treatment for HIV with ART. +
        • +
      +
      + Timing of ART⌃ +
      +
        +
      • + Multiple studies have demonstrated the benefits of ART initiation among persons living with HIV + during TB treatment, including a reduction in mortality. +
        • +
      • + However, the use of ART among persons living with HIV with active TB disease is complicated by + overlapping toxicity profiles of some antituberculosis and antiretroviral drugs; complex drug-drug + interactions; and the occurrence of “paradoxical” reactions or immune reconstitution inflammatory + syndrome (IRIS). +
        • +
      +
      + All persons living with HIV who are diagnosed with active TB disease and not on ART should be started on ART as follows:⌃ -
      -
        -
      • - CD4 T lymphocyte (CD4) cell counts <50 cells/mm3: HHS guidelines recommend - initiating ART as soon as possible, but within 2 weeks of starting TB treatment. -
        • -
      • - CD4 counts ≥50 cells/mm3: Initiate ART within 2 to 8 weeks of starting TB - treatment. -
        • -
      • - During pregnancy, regardless of CD4 count: Initiate ART as early as feasible for treatment of - the person with HIV and prevention of HIV transmission to the infant. -
        • -
      • - With TB meningitis: Initiate ART after TB meningitis is under control and after at least 2 - weeks of anti-TB treatment to reduce the risk of life-threatening inflammation in a closed space - (i.e., brain) as a result of immune reconstitution. Generally, initiation of ART in this setting is - recommended 4 to 8 weeks after initiation of therapy for TB meningitis. -
        • +
        +
          +
        • + CD4 T lymphocyte (CD4) cell counts <50 cells/mm3: HHS guidelines recommend + initiating ART as soon as possible, but within 2 weeks of starting TB treatment. +
          • +
        • + CD4 counts ≥50 cells/mm3: Initiate ART within 2 to 8 weeks of starting TB + treatment. +
          • +
        • + During pregnancy, regardless of CD4 count: Initiate ART as early as feasible for treatment of + the person with HIV and prevention of HIV transmission to the infant. +
          • +
        • + With TB meningitis: Initiate ART after TB meningitis is under control and after at least 2 + weeks of anti-TB treatment to reduce the risk of life-threatening inflammation in a closed space + (i.e., brain) as a result of immune reconstitution. Generally, initiation of ART in this setting is + recommended 4 to 8 weeks after initiation of therapy for TB meningitis. +
          • +
        +
        + + +

        + As noted above, there are certain situations where ART therapy should be delayed when treating persons with + active TB disease who have HIV co-infection. A study of people living with HIV with TB meningitis found that + early ART was associated with an increase in severe adverse events and no mortality benefit. Thus, timing of + ART initiation in persons with active TB disease who have HIV co-infection should take into account both the + degree of immune suppression and site of disease (see Table 16 and recommendations above). +

        +

        Table 13. Antiretroviral Therapy (ART) and Treatment of Persons Living with HIV and Active TB

        +
        + + + + + + + + + + + + + + + + + + + + + + +
        HHS Panel Recommendations on treatment of Tuberculosis Disease with HIV co-infection: Timing of Antiretroviral Therapy (ART) Initiation relative to TB treatment
        CD4 count and/or clinical status at time of TB diagnosisART Initiation
        < 50 cells/mm³ iwithin 2 weeks of starting TB therapy.
        > 50 cells/mm³ iby 8 to 12 weeks of starting TB therapy
        Pregnant, any CD4 countAs early as feasible
        + +

        Above based on guidelines developed by the Department of Health and Human Services (DHHS) Panel on Guidelines for Use of Antiretroviral Agents for Adults and Adolescents and Use of Antiretroviral Drugs in Pregnant Women with HIV Infection and Interventions to Reduce Perinatal Transmission in the United States, last reviewed and updated April 15, 2019
        (https://aidsinfo.nih.gov/guidelines).

        +
        + +

        Table 14. Antiretroviral Therapy (ART) and Treatment of Persons + Living with HIV and Active TB

        +
        +

        + + Principle: Despite Drug Interactions, a Rifamycin (Rifampin or Rifabutin) Should Be Included in TB Regimens for Patients Receiving ART, with Dosage Adjustment if Necessary + +

        + +
        +
          +
          • +
          • +
        +
        +

        + + Integrase-based ART regimens. Dolutegravir is the preferred integrase for TB/HIV co-infection treatment. + +

        -

        - As noted above, there are certain situations where ART therapy should be delayed when treating persons with - active TB disease who have HIV co-infection. A study of people living with HIV with TB meningitis found that - early ART was associated with an increase in severe adverse events and no mortality benefit. Thus, timing of - ART initiation in persons with active TB disease who have HIV co-infection should take into account both the - degree of immune suppression and site of disease (see Table 16 and recommendations above). -

        -

        Table 16. Antiretroviral Therapy (ART) and Treatment of Persons - Living with HIV and Active TB

        -
        - - - - - - +

        1a. Patients receiving rifampin-based TB treatment.

        +
        HHS Panel Recommendations on treatment of Tuberculosis Disease with HIV - co-infection: Timing of Antiretroviral Therapy (ART) Initiation relative to TB treatment -
        + - - + + + - +
          +
        • DTG (Tivicay) BID + TAF/FTC (Descovy)
          • +
        • DTG (Tivicay) BID + ABC/3TC
          • +
        + - - + + - - + + +
        CD4 count and/or clinical status at time of TB diagnosisART InitiationPreferredDTG (Tivicay) BID + TDF/FTC (Truvada)
        Alternative - < 50 cells/mm³within 2 weeks of starting TB therapy.
        > 50 cells/mm³within 2-8 weeks of starting TB therapyFrequencyDaily for both preferred and alternative
        Pregnant, any CD4 countAs early as feasibleNoteTriumeq is a combination of DTG/ABC/3tc
        -

        ** EXCEPTION: tuberculous meningitis. To avoid life-threatening CNS immune reconstitution inflammatory - syndrome (IRIS), persons living with HIV and tuberculous meningitis should not - be started on ART until AFTER the TB meningitis is under control and at least two weeks anti-TB treatment -

        -

        - PREVENTING IRIS (Immune Reconstitution Inflammatory Syndrome): prednisone 40 mg/day for 2 weeks followed by 20 mg/day for 2 weeks is recommended for people with CD4 100 cells/mm3 who start ART within 30 days of TB treatment, are responding well to treatment, do not have known or suspected rifampin resistance, Kaposi sarcoma, or active hepatitis B. This recommendation does not apply to people with CNS TB for whom steroids are recommended from the time TB treatment is started. -

        -

        - Above based on guidelines developed by the Department of Health and Human Services (DHHS) Panel on Guidelines for Use of Antiretroviral Agents for Adults and Adolescents and Use of Antiretroviral Drugs in Pregnant Women living with HIV and Interventions to Reduce Perinatal Transmission in the United States, last reviewed and updated October 29, 2024 (https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-opportunistic-infections/mycobacterium?view=full) -

        - -
        -

        Table 17. Antiretroviral Therapy (ART) and Treatment of Persons - Living with HIV and Active TB

        -
        - - - - - - +

        1b. Patients receiving rifabutin-based TB treatment

        +
        Principle: Despite Drug Interactions, a Rifamycin (Rifampin or Rifabutin) Should Be Included - in TB Regimens for Patients - Receiving ART, with Dosage Adjustment if Necessary (see Table SMR11 for dosage - adjustments). -
        + - + + + + + + + + + + + + + + + +
        Option 1: Integrase-based ART regimens. Dolutegravir is the preferred integrase for TB/HIV co-infection treatment.

        - Option 1a: Patients receiving rifampin-based TB treatment.

        - Preferred: DTG (Tivicay) BID + TDF/FTC (Truvada) daily
        - Alternative choices:
        - - (1) DTG (Tivicay) BID + TAF/FTC (Descovy) daily
        - - (2) DTG (Tivivay) BID + ABC/3TC daily (note: Triumeq is a combination of - - DTG/ABC/3tc)

        - Option 1b: Patients receiving rifabutin-based TB treatment

        - Preferred: DTG (Tivicay) daily + TDF/FTC (Truvada) daily
        +         		PreferredDTG (Tivicay) BID + TDF/FTC (Truvada)
        Alternative +
          +
        • DTG (Tivicay) BID + TAF/FTC (Descovy)
          • +
        • DTG/ABC/3TC (Triumeq)
          • +
        +
        FrequencyDaily for both preferred and alternative
        NoteThe FDA does not recommend using TAF with rifampin or rifabutin
        - Alternative choices:
        +

        Abbreviations:

        +
          +
        • NRTIs: nucleoside/-tide reverse transcriptase inhibitors
          • +
        • NNRTIs: non-nucleoside reverse transcriptase inhibitors
          • +
        • PIs: protease inhibitors
          • +
        • /r: boosted with ritonavir
          • +
        • TDF: Tenofovir disoproxil fumarate
          • +
        • TAF: Tenofovir alafenamide
          • +
        • FTC: Emtricitabine
          • +
        • 3TC: Lamivudine
          • +
        • ABC: Abacavir
          • +
        • ATV/r: Atazanavir/ritonavir
          • +
        • DRV/r: Darunavir/ritonavir
          • +
        • DTG: Dolutegravir
          • +
        - (1) DTG (Tivicay) daily + TAF/FTC (Descovy) daily
        +

        Source:

        +
          +
        • Above based on guidelines developed by the Department of Health and Human Services (DHHS) Panel on Guidelines for Use of Antiretroviral Agents for Adults and Adolescents and Use of Antiretroviral Drugs in Pregnant Women living with HIV and Interventions to Reduce
          • +
        • Perinatal Transmission in the United States, last reviewed and updated October 29, 2024 (https://aidsinfo.nih.gov/guidelines).
          • +
        +
        - (2) DTG/ABC/3TC (Triumeq) daily

        +
        +

        + + PI-based ART regimens + + (cannot be used with rifampin, must use with dose-adjusted rifabutin) +

        - Note: The FDA does not recommend using TAF with rifampin or rifabutin -

      • + + + + + - + + + +
      PreferredATV/r + TDF/FTC (Truvada)
      Alternative - Option 2: PI-based ART regimens (cannot be used with rifampin, must use with dose-adjusted rifabutin)

      - Option 2a

      - ATV/r daily + TDF/FTC (Truvada) daily
      - Alternative choices:

      - - (1) ATV/r daily + TAF/FTC (Descovy) daily
      - - (2) ATV/r daily + ABC/3TC daily

      - - Option 2b

      - DRV/r daily + TDF/FTC (Truvada) daily

      - - (1) DRV/r daily + TAF/FTC (Descovy) daily
      - (2) DRV/r daily + ABC/3TC daily +
        +
      • ATV/r + TAF/FTC (Descovy)
        • +
      • ATV/r + ABC/3TC
        • +
      - 1- PI’s have high barrier to resistance. However, given rifabutin is given at half-dose when used with PI’s adherence to ART should be closely monitored. Poor adherence to PI’s while on rifabutin increases risk for rifampin resistance.
      +       		FrequencyDaily for both preferred and alternative
      - 2- The FDA does not recommend using TAF with rifampin or rifabutin.
      - 3- Cobicistat cannot be used with rifabutin -

      + + + + + - + + + + +
      PreferredDRV/r + TDF/FTC (Truvada)
      Alternative - Choice for Pregnant Women living with HIV and with Active TB : Expert consultation advised. Options 1a and 1b are currently preferred in pregnancy. +
        +
      • DRV/r + TAF/FTC (Descovy)
        • +
      • DRV/r + ABC/3TC
        • +
      FrequencyDaily for both preferred and alternative
      -
        +

        Additional Notes:

        +
          +
        • PI’s have high barrier to resistance. However, given rifabutin is given at half-dose when used with PI’s adherence to ART should be closely monitored. Poor adherence to PI’s while on rifabutin increases risk for rifampin resistance.
          • +
        • The FDA does not recommend using TAF with rifampin or rifabutin.
          • +
        • Cobicistat cannot be used with rifabutin.
          • +
        + +

        Abbreviations:

        +
        • NRTIs: nucleoside/-tide reverse transcriptase inhibitors
        • NNRTIs: non-nucleoside reverse transcriptase inhibitors
        • PIs: protease inhibitors
          • @@ -291,478 +305,797 @@

          Table 17. Antiretroviral Therapy (AR
        • 3TC: Lamivudine
        • ABC: Abacavir
        • ATV/r: Atazanavir/ritonavir
          • -
        • DRV/r: Daraunavir/ritonavir
          • +
        • DRV/r: Darunavir/ritonavir
        • DTG: Dolutegravir

        + +

        Source:

        +
          +
        • Above based on guidelines developed by the Department of Health and Human Services (DHHS) Panel on Guidelines for Use of Antiretroviral Agents for Adults and Adolescents and Use of Antiretroviral Drugs in Pregnant Women living with HIV and Interventions to Reduce
          • +
        • Perinatal Transmission in the United States, last reviewed and updated October 29, 2024 (https://aidsinfo.nih.gov/guidelines).
          • +
        +

    + +

    - Above based on guidelines developed by the Department of Health and Human Services (DHHS) Panel on Guidelines for Use of Antiretroviral Agents for Adults and Adolescents and Use of Antiretroviral Drugs in Pregnant Women living with HIV and Interventions to Reduce Perinatal Transmission in the United States, last reviewed and updated October 29, 2024 (http://aidsinfo.nih.gov/guidelines). + + Choice for Pregnant Women living with HIV and with Active TB +

    -
    +

    2a

    + + + + + + + +
    Notes +
      +
    • Expert consultation advised.
      • +
    • Options 1a and 1b are currently preferred in pregnancy.
      • +
    +
    -

    - Persons who are already on ART at the time of TB diagnosis, generally should be continued on the ART - treatment (though ART regimen may need to be adjusted). -

    -

    Choice of ART⌃

    -
    +

    Source:

      -
    • - Because of the potential for significant drug interactions and overlapping toxicities, the choice of - ART among persons living with HIV who have active TB disease should be made only after direct - communication between HIV and tuberculosis care providers. -
      • -
    • - Any change in either the TB medications or the ART regimen should be immediately shared between the - two providers. -
      • +
    • Above based on guidelines developed by the Department of Health and Human Services (DHHS) Panel on Guidelines for Use of Antiretroviral Agents for Adults and Adolescents and Use of Antiretroviral Drugs in Pregnant Women living with HIV and Interventions to Reduce
      • +
    • Perinatal Transmission in the United States, last reviewed and updated October 29, 2024 (https://aidsinfo.nih.gov/guidelines).
    - -

    There are clinically important drug-drug interactions between - the rifamycins (e.g., rifampin, rifabutin, rifapentene) and some of the antiretroviral drugs, especially - integrase and protease inhibitors.⌃

    -
    -
      +
    + +

    + Persons who are already on ART at the time of TB diagnosis, generally should be continued on the ART + treatment (though ART regimen may need to be adjusted). +

    +

    Choice of ART⌃

    +
    +
      +
    • + Because of the potential for significant drug interactions and overlapping toxicities, the choice of + ART among persons living with HIV who have active TB disease should be made only after direct + communication between HIV and tuberculosis care providers. +
      • +
    • + Any change in either the TB medications or the ART regimen should be immediately shared between the + two providers. +
      • +
    +
    + +

    There are clinically important drug-drug interactions between + the rifamycins (e.g., rifampin, rifabutin, rifapentene) and some of the antiretroviral drugs, especially + integrase and protease inhibitors.⌃

    +
    +
      +
    • + The rifamycins are inducers of the cytochrome P450-3A (CYP3A) system in the liver and thereby + decrease serum concentrations of drugs metabolized by this system including integrase and protease + inhibitors. +
      • +
    • + Rifampin is a potent inducer of the CYP3A, while rifabutin is a less potent inducer. Rifampin cannot + be given with most protease inhibitors because it results in low serum levels of these drugs. +
      • +
    • + Rifabutin has less of an effect and therefore can be used with certain protease inhibitors as + described below. +
      • +
    • + Rifampin and rifabutin can be given with certain integrase inhibitors (https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-arv/coinfections-tuberculosis-hiv). +
      • +
    +
    +

    + The protease inhibitors also affect rifamycin metabolism and because the rifamycin metabolism is retarded by + these drugs, the dose of rifabutin needs to be reduced in order to avoid rifabutin related toxicity. +

    +

    + Despite these drug-drug interactions, a rifamycin (rifampin or rifabutin) should ALWAYS be included in the + treatment regimen for drug-susceptible TB among persons living with HIV. +

    + +

    Rifampin can be given with the following + antiretrovirals:⌃

    +
    +
      +
    • + MOST Nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs) (e.g., zidovudine, lamivudine, + emtricitabine, tenofovir disoproxil fumarate (TDF), + + abacavir). Tenofovir alafenamide (TAF) is not currently recommended for use in combination with + rifamycins. +
      • +
    • + SELECTED Non-nucleoside reverse transcriptase inhibitors (NNRTIs): efavirenz only (all others are + contraindicated for coadministration with rifampin). +
      • +
    • + Selected Integrase inhibitors: raltegravir and dolutegravir. The dose of raltegravir must be + increased to 800 mg twice daily (BID) and the dose of dolutegravir must be increased to 50 mg BID + for patients on rifampin. Neither raltegravir or dolutegravir require a dosing change when used with + rifabutin. Bictegravir (a component of Biktarvy) should NOT be given in combination with any + rifamycin drugs (rifampin, rifabutin, rifapentine). +
      • +
    +
    + +

    Rifampin should NOT be used with the following:⌃

    +
    +
      +
    • + Tenofoviral afenamide (TAF) +
      • +
    • + Protease inhibitors +
      • +
    • + Nevirapine, etravirine, rilpivarine (NNRTIs) +
      • +
    • + Bictegravir (including Biktarvy), elvitegravir +
      • +
    +
    + +

    + A summary of preferred treatment options for patients with tuberculosis disease who are HIV co-infected is + shown in Table 15 and Table 16. For additional + information refer to updated HHS guidelines, visit https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-arv/tuberculosishiv-coinfection?view=full +

    +

    Table 15. Summary of Recommendations for Treatment of Active TB Disease in + Persons with HIV

    + + +
    +
    +
    • - The rifamycins are inducers of the cytochrome P450-3A (CYP3A) system in the liver and thereby - decrease serum concentrations of drugs metabolized by this system including integrase and protease - inhibitors. +
    • - Rifampin is a potent inducer of the CYP3A, while rifabutin is a less potent inducer. Rifampin cannot - be given with most protease inhibitors because it results in low serum levels of these drugs. +
    • - Rifabutin has less of an effect and therefore can be used with certain protease inhibitors as - described below. +
    • - Rifampin and rifabutin can be given with certain integrase inhibitors (https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-arv/coinfections-tuberculosis-hiv. -
      • -
    -
    -

    - The protease inhibitors also affect rifamycin metabolism and because the rifamycin metabolism is retarded by - these drugs, the dose of rifabutin needs to be reduced in order to avoid rifabutin related toxicity. -

    -

    - Despite these drug-drug interactions, a rifamycin (rifampin or rifabutin) should ALWAYS be included in the - treatment regimen for drug-susceptible TB among persons living with HIV. -

    - -

    Rifampin can be given with the following - antiretrovirals:⌃

    -
    -
      -
    • - MOST Nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs) (e.g., zidovudine, lamivudine, - emtricitabine, tenofovir disoproxil fumarate (TDF), - - abacavir). Tenofovir alafenamide (TAF) is not currently recommended for use in combination with - rifamycins. +
    • - SELECTED Non-nucleoside reverse transcriptase inhibitors (NNRTIs): efavirenz only (all others are - contraindicated for coadministration with rifampin). +
    • - Selected Integrase inhibitors: raltegravir and dolutegravir. The dose of raltegravir must be - increased to 800 mg twice daily (BID) and the dose of dolutegravir must be increased to 50 mg BID - for patients on rifampin. Neither raltegravir or dolutegravir require a dosing change when used with - rifabutin. Bictegravir (a component of Biktarvy) should NOT be given in combination with any - rifamycin drugs (rifampin, rifabutin, rifapentine). +
      • -
    -
    - -

    Rifampin should NOT be used with the following:⌃

    -
    -
    • - Tenofoviral afenamide (TAF) +
    • - Protease inhibitors +
    • - Nevirapine, etravirine, rilpivarine (NNRTIs) +
    • - Bictegravir (including Biktarvy), elvitegravir +
    -

    - A summary of preferred treatment options for patients with tuberculosis disease who are HIV co-infected is - shown in - Table 18 and - Table 19. For additional - information refer to updated HHS guidelines, visit https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-arv/tuberculosishiv-coinfection?view=full -

    -

    Table 18. Dosage Adjustments for ART and Rifamycins when used in - Combination

    -
    -
    - - - -
    +
    +

    + When to start ART +

    -
    -

    Dolutegravir (DTG)

    - - - - - - - - - - - - - - - -
    DrugDosing
    Rifampin (RIF)RIF: No change (600 mg)
    DTG: Increase to 50 mg BID
    Rifabutin (RBT)RBT: No change (300 mg)
    DTG: No change (50 mg)
    -
    + + + + + + + + + + + +
    What to do +
      +
    • + CD4 <50: start ART within + 2 weeks of TB therapy +
      • +
    • + CD4 ≥50: start ART by + 8–12 weeks. +
      • +
    • + TB meningitis: defer starting ART and + seek expert advice as CNS TB IRIS may increase morbidity + and mortality +
      • +
    +
    Key details/caveats + Early ART ↓ mortality.
    + CNS TB early ART ↑ severe IRIS risk. +
    +
    -
    -

    ATV/r, DRV/r

    - - - - - - - - - - - - - - - -
    DrugDosing
    Rifampin (RIF)DO NOT USE
    Rifabutin (RBT)RBT: decrease to 150 mg/d
    PIs: no change
    -
    +
    +

    + How to prevent IRIS in TB/HIV +

    -
    -

    Efavirenz (EFV)
    (Note: No longer a first line ART)

    - - - - - - - - - - - - - - - -
    DrugDosing
    Rifampin (RIF)RIF no change (600 mg)
    EFV: no change (600 mg qhs)
    Rifabutin (RBT)DO NOT USE
    -
    + + + + + + + + + + + +
    What to do +
      +
    • + Consider prednisone 40 mg/day for + 2 weeks, then + 20 mg/day for + 2 weeks for patients with + CD4 ≤100 who starting ART within 30 days + of TB treatment initiation and are responding well to TB + therapy. +
      • +
    • Consult with expert in TB/HIV.
      • +
    +
    Key details/caveats + Contraindicated for patients with rifampin-resistant TB, + Kaposi sarcoma, or active hepatitis B. +
    +
    + +

    - Department of Human Health Services links for ART drug-drug interactions – these are updated frequently + TB Regimen: Drug-susceptible TB (DS_TB)

    -

    Protease inhibitors: https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-arv/drug-interactions-protease-inhibitors?view=full + + + + + + + + + + + + +
    What to do + Use standard 6-month HRZE → HR regimen + (intensive phase 2 months HRZE, continuation phase 4-7 months + HR) +
    Key details/caveatsRemains the global standard for HIV-associated TB
    +

    + +
    +

    + Core ART principles with rifamycins

    -

    NNRTIs: https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-arv/drug-interactions-nnrti?view=full + + + + + + + + + + + +
    What to do + Rifamycins (rifampin, rifabutin, rifapentine) are the most + important TB drug in the treatment of DS-TB and every effort + should be made to include them in the treatment regimen. + However, rifamycins have many drug-drug interactions. + i +
    Key details/caveats + Rifamycins strongly induce CYP3A, UGT, P-gp, causing major ARV + interactions. +
    +

    + +
    +

    + INSTIs with rifamycin

    -

    NRTIs: https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-arv/drug-interactions-nrti?view=full + + + + + + + + + + + +
    What to do + Dolutegravir (DTG): Increase does to 50 mg + twice daily while on rifampin. + Bictegravir (BIC) (INSTI in Biktarvy) is + contraindicated with rifampin and other rifamycins. +
    Key details/caveats +
      +
    • DTG BID validated in HIV–TB.
      • +
    • BIC levels drop severely.
      • +
    +
    +

    + +
    +

    + NNRTIs with rifampin

    -

    Integrase inhibitors: https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-arv/drug-interactions-insti?view=full + + + + + + + + + + + +
    What to doEfavirenz 600 mg daily is compatible.
    Key details/caveats + Efavirenz generally maintained at therapeutic levels with + rifampin. +
    +

    + +
    +

    + Boosted PIs with rifampin

    -

    *Preliminary data suggest that there is an increased risk of neural tube defects in infants born to women - who were receiving DTG at the time of conception. DTG is contraindicated for pregnant women during first - trimester and for women who are planning to become pregnant or are not using effective contraception. - DTG is the preferred integrase inhibitor after first trimester.

    + + + + + + + + + + + +
    What to do + Do NOT use rifampin with ritonavir- or + cobicistat-boosted PIs. Use rifabutin instead + of rifampin if PI required (can use with ritonavir, cannot use + with cobicistat). +
    Key details/caveats +
      +
    • Monitor for uveitis and neutropenia with rifabutin.
      • +
    • + Dose adjustment for rifabutin generally required; consult + with HIV/TB expert. +
      • +
    +
    +
    -
      -
    • NNRTIs: non-nucleoside reverse transcriptase inhibitors
      • -
    • PIs: protease inhibitors
      • -
    • ATV/r: Atazanavir/ritonavir
      • -
    • DRV/r: Daraunavir/ritonavir
      • -
    • LPV/r: Lopinavir/ritonavir
      • -
    • RAL: Raltegravir
      • -
    • DTG: Dolutegravir
      • -
    • /c : boosted with cobicistat
      • -
    +
    +

    + NRTI backbone +

    + + + + + + + + + + + + +
    What to do + Use TDF/FTC (Truvada) or + 3TC. General recommendations are to avoid + TAF (i.e., TAF/FTC [Descovy]) use with + rifamycins. However, TAF can be used with rifampin with + caution and close monitoring of virologic response per the + DHHS/NIH HIV treatment guidelines. +
    Key details/caveats + Rifamycins lower plasma TAF concentration, but intracellular + levels are preserved. +
    +
    -

    Table 18 is based on guidelines developed by the Department of Health and Human Services (DHHS) Panel on - Guidelines for Use of Antiretroviral Agents for Adults and Adolescents and Use of Antiretroviral Drugs - in Pregnant Women with HIV Infection and Interventions to Reduce Perinatal Transmission in the United - States, last reviewed and updated April 15, 2019 - (aidsinfo.nih.gov/guidelines) +

    +

    + TB-IRIS

    -

    1-Data on integrase inhibitors and pregnancy outcomes is rapidly evolving and DHHS - guidelines are frequently updated.

    - -

    2-Cobicistat is currently not recommended for pregnant women.

    - -

    Table 19. Adjunctive Use of Corticosteroid Therapy

    -
    -
    - - - - - - - - - - -
    + + + + + + + + + + + +
    What to do + Continue ART. NSAIDs for mild IRIS. + Prednisone for moderate–severe IRIS. +
    Key details/caveats + ART should NOT be stopped except in life-threatening IRIS. +
    +
    -
    - - - - - - - - - - - - - - - -
    Length of therapy6 months
    CorticosteroidsNot recommended
    Additional management considerationsPursue microbiologic proof of diagnosis prior to starting Rx
    -
    +
    +

    + TB Meningitis +

    -
    - - - - - - - - - - - - - - - -
    Length of therapy6 to 9 months
    CorticosteroidsNot recommended
    Additional management considerationsExtend to 12 months if hardware is present
    -
    + + + + + + + + + + + +
    What to do + Use adjunctive steroids. Delay start of ART. + Seek expert advice as CNS TB IRIS may increase morbidity and + mortality +
    Key details/caveatsReduces mortality and CNS IRIS.
    +
    -
    - - - - - - - - - - - - - - - -
    Length of therapy6 to 9 months
    CorticosteroidsNot recommended for TB rx but may be indicated for cord compression
    Additional management considerationsMost spine infection can be cured with medical Rx. Surgery indicated for relief of - cord - compression, progressive disease despite medical therapy, instability of the spine. -
    -
    +
    +

    Abbreviations:

    +
      +
    • ART – Antiretroviral therapy
      • +
    • ARV – Antiretroviral
      • +
    • BIC – Bictegravir
      • +
    • CNS – Central nervous system
      • +
    • CYP3A / CYP3A4 – Major drug-metabolizing enzymes
      • +
    • DS-TB – Drug-susceptible TB
      • +
    • DTG – Dolutegravir
      • +
    • EFV – Efavirenz
      • +
    • FTC – Emtricitabine
      • +
    • HRZE – TB intensive-phase regimen:
      • +
    • H = Isoniazid
      • +
    • R = Rifampin
      • +
    • Z = Pyrazinamide
      • +
    • E = Ethambutol
      • +
    • IRIS – Immune reconstitution inflammatory syndrome
      • +
    • INSTI – Integrase strand transfer inhibitor
      • +
    • NNRTI – Non-nucleoside reverse transcriptase inhibitor
      • +
    • + NRTI – Nucleoside/nucleotide reverse transcriptase inhibitor +
      • +
    • PI – Protease inhibitor
      • +
    • P-gp – P-glycoprotein (drug efflux transporter)
      • +
    • RFB (or RIFB) – Rifabutin
      • +
    • RPT – Rifapentine
      • +
    • TAF – Tenofovir alafenamide
      • +
    • TDF – Tenofovir disoproxil fumarate
      • +
    • + TB-IRIS – TB-associated immune reconstitution inflammatory + syndrome +
      • +
    • + UGT (UDP-glucuronosyltransferase): A liver enzyme family that + metabolizes many drugs. Rifamycins induce UGT1A1, lowering levels + of drugs like dolutegravir and bictegravir. +
      • +
    -
    - - - - - - - - - - - - - - - - - - - -
    Length of therapy9 to 12 months
    CorticosteroidsStrongly recommended
    Steroid dosingA and C ≥ 25kg: 12 mg/day of dexamethasone x 3 weeks followed by 3-week taper -

    C < 25kg: 8 mg/day of dexamethasone for 3 weeks followed by 3-week taper

    -
    Additional management considerationsMost spine infection can be cured with medical Rx. Surgery indicated for relief of - cord - compression, progressive disease despite medical therapy, instability of the spine. -
    -
    +

    Source:

    + +
    +
    + +

    Table 16. Guidelines for Treatment of Extrapulmonary Tuberculosis

    +
    + +
    +
      +
      • +
      • +
      • +
      • +
      • +
      • +
      • +
      • +
      • +
      • +
    +
    -
    - - - - - - - - - - - - - - - -
    Length of therapy9-12 months
    CorticosteroidsStrongly recommended
    Additional management considerationsNegative CSF culture or PCR test does NOT exclude this diagnosis -

    Follow CSF profile for response to therapy

    -
    -
    +
    + + + + + + + + + + + + + + + +
    Length of therapy6 months
    CorticosteroidsNot recommended
    Additional management considerationsPursue microbiologic proof of diagnosis prior to starting Rx
    +
    -
    - - - - - - - - - - - - - - - -
    Length of therapy6 months
    CorticosteroidsNot recommended
    Additional management considerationsEmpyema may require decortication
    -
    +
    + + + + + + + + + + + + + + + +
    Length of therapy6 to 9 months
    CorticosteroidsNot recommended
    Additional management considerationsExtend to 12 months if hardware is present
    +
    -
    - - - - - - - - - - - - - - - -
    Length of therapy6 months
    CorticosteroidsNO LONGER routinely RECOMMENDED
    Additional management considerationsConsider steroids for patients at highest risk of later constriction: - large pericardial effusions high levels of inflammatory cells or markers in - pericardial fluid those - with early signs of constriction
    -
    +
    + + + + + + + + + + + + + + + +
    Length of therapy6 to 9 months
    CorticosteroidsNot recommended for TB rx but may be indicated for cord compression
    Additional management considerationsMost spine infection can be cured with medical Rx. Surgery indicated for relief of + cord + compression, progressive disease despite medical therapy, instability of the spine. +
    +
    -
    - - - - - - - - - - - - - - - -
    Length of therapy6 months
    CorticosteroidsNot recommended
    Additional management considerationsObtain cultures from blood, urine and sputum in addition to clinically apparent - sites of disease.
    -
    +
    + + + + + + + + + + + + + + + + + + + +
    Length of therapy9 to 12 months
    CorticosteroidsStrongly recommended
    Steroid dosingA and C ≥ 25kg: 12 mg/day of dexamethasone x 3 weeks followed by 3-week taper +

    C < 25kg: 8 mg/day of dexamethasone for 3 weeks followed by 3-week taper

    +
    Additional management considerationsMost spine infection can be cured with medical Rx. Surgery indicated for relief of + cord + compression, progressive disease despite medical therapy, instability of the spine. +
    +
    -
    - - - - - - - - - - - - - - - -
    Length of therapy6 months
    CorticosteroidsNot recommended
    Additional management considerations
    -
    +
    + + + + + + + + + + + + + + + +
    Length of therapy9-12 months
    CorticosteroidsStrongly recommended
    Additional management considerationsNegative CSF culture or PCR test does NOT exclude this diagnosis +

    Follow CSF profile for response to therapy

    +
    +
    -
    - - - - - - - - - - - - - - - -
    Length of therapy6 months
    CorticosteroidsNot recommended
    Additional management considerations
    -
    +
    + + + + + + + + + + + + + + + +
    Length of therapy6 months
    CorticosteroidsNot recommended
    Additional management considerationsEmpyema may require decortication
    +
    -

    - 2 mg/kg prednisone daily over three weeks, followed by taper Maximum dose 60 mg
    OR
    - Dexamethasone 0.3-0.6 mg/kg daily over three weeks, followed by taper Round to nearest tablet size - (2, 4, 6 mg) Maximum dose 12 mg -

    -
    +
    + + + + + + + + + + + + + + + +
    Length of therapy6 months
    CorticosteroidsNO LONGER routinely RECOMMENDED
    Additional management considerationsConsider steroids for patients at highest risk of later constriction: + large pericardial effusions high levels of inflammatory cells or markers in + pericardial fluid those + with early signs of constriction
    +
    + +
    + + + + + + + + + + + + + + + +
    Length of therapy6 months
    CorticosteroidsNot recommended
    Additional management considerationsObtain cultures from blood, urine and sputum in addition to clinically apparent + sites of disease.
    +
    + +
    + + + + + + + + + + + + + + + +
    Length of therapy6 months
    CorticosteroidsNot recommended
    Additional management considerations
    + +
    + + + + + + + + + + + + + + + +
    Length of therapy6 months
    CorticosteroidsNot recommended
    Additional management considerations
    +
    + +

    + 2 mg/kg prednisone daily over three weeks, followed by taper Maximum dose 60 mg
    OR
    + Dexamethasone 0.3-0.6 mg/kg daily over three weeks, followed by taper Round to nearest tablet size + (2, 4, 6 mg) Maximum dose 12 mg +

    +
    diff --git a/app/src/main/assets/pages/5_treatment_of_current_(active)_disease_therapy__h__immune_reconstitution_inflammatory_syndrome.html b/app/src/main/assets/pages/5_treatment_of_current_(active)_disease_therapy__h__immune_reconstitution_inflammatory_syndrome.html index 87bce48..5bc7512 100644 --- a/app/src/main/assets/pages/5_treatment_of_current_(active)_disease_therapy__h__immune_reconstitution_inflammatory_syndrome.html +++ b/app/src/main/assets/pages/5_treatment_of_current_(active)_disease_therapy__h__immune_reconstitution_inflammatory_syndrome.html @@ -19,7 +19,7 @@
    - +

    V. Treatment of Current (Active) Disease Therapy

    diff --git a/app/src/main/assets/pages/5_treatment_of_current_(active)_disease_therapy__i__treatment_of_extrapulmonary_tb.html b/app/src/main/assets/pages/5_treatment_of_current_(active)_disease_therapy__i__treatment_of_extrapulmonary_tb.html index dd64a51..32ede7c 100644 --- a/app/src/main/assets/pages/5_treatment_of_current_(active)_disease_therapy__i__treatment_of_extrapulmonary_tb.html +++ b/app/src/main/assets/pages/5_treatment_of_current_(active)_disease_therapy__i__treatment_of_extrapulmonary_tb.html @@ -19,7 +19,7 @@
    - +

    V. Treatment of Current (Active) Disease Therapy

    @@ -47,7 +47,7 @@ and the absence of granuloma formation does not exclude the diagnosis of TB. Surgery may be necessary to obtain specimens for diagnosis and to treat such processes as constrictive pericarditis or spinal cord compression from Pott’s disease. Evidence-based guidelines for the treatment of extrapulmonary TB and adjunctive use of - corticosteroids are shown in Table 20.

    + corticosteroids are shown in Table 17.

    diff --git a/app/src/main/assets/pages/5_treatment_of_current_(active)_disease_therapy__j__adjunctive_use_of_corticosteroid_therapy.html b/app/src/main/assets/pages/5_treatment_of_current_(active)_disease_therapy__j__adjunctive_use_of_corticosteroid_therapy.html index 2363aab..0118dd0 100644 --- a/app/src/main/assets/pages/5_treatment_of_current_(active)_disease_therapy__j__adjunctive_use_of_corticosteroid_therapy.html +++ b/app/src/main/assets/pages/5_treatment_of_current_(active)_disease_therapy__j__adjunctive_use_of_corticosteroid_therapy.html @@ -1,153 +1,339 @@ - + - - - - + + + + Adjunctive Use of Corticosteroid Therapy (Table 19) - - - - - + + + + + - - - -
    -
    + +
    +
    -
    -
    - -
    -

    V. Treatment of Current (Active) Disease Therapy

    +
    +
    +
    -

    Last Updated October 2025

    +

    + V. Treatment of Current (Active) Disease Therapy +

    +
    +

    Last Updated October 2025

    -
    -
    - -

    Adjunct corticosteroid therapy is indicated in the treatment of tuberculous meningitis⌃

    -
    +
    +
    + +

    + Adjunct corticosteroid therapy is indicated in the treatment of + tuberculous meningitis⌃ +

    +
      -
    • - As its use along with appropriate antituberculosis drugs is associated with a lower mortality. -
      • -
    • - For patients with tuberculous meningitis, dexamethasone or prednisolone is recommended as adjunct therapy for a total of 6 to 8 weeks. An initial dose of 8 mg per day of dexamethasone for children < 25 kg and 12 mg per day for children > 25 kg and adults can be used. The initial dose is given for 3 weeks and then the dose should be tapered during the following 3 weeks. -
      • -
    • - Adjunctive corticosteroids in treatment of pericardial tuberculosis did not reduce mortality, tamponade or constrictive physiology in a large randomized clinical trial and are thus no longer routinely recommended. -
      • -
    • - Some experts would use corticosteroids in selected patients with TB pericarditis: those with large effusions and/or high levels of inflammation in pericardial fluid. -
      • +
    • + As its use along with appropriate antituberculosis drugs is + associated with a lower mortality. +
      • +
    • + For patients with tuberculous meningitis, dexamethasone or + prednisolone is recommended as adjunct therapy for a total of 6 to 8 + weeks. An initial dose of 8 mg per day of dexamethasone for children + < 25 kg and 12 mg per day for children > 25 kg and adults can be + used. The initial dose is given for 3 weeks and then the dose should + be tapered during the following 3 weeks. +
      • +
    • + Adjunctive corticosteroids in treatment of pericardial tuberculosis + did not reduce mortality, tamponade or constrictive physiology in a + large randomized clinical trial and are thus no longer routinely + recommended. +
      • +
    • + Some experts would use corticosteroids in selected patients with TB + pericarditis: those with large effusions and/or high levels of + inflammation in pericardial fluid. +
    -
    +
    + +

    + Table 16. Guidelines for Treatment of Extrapulmonary Tuberculosis: + Length of Therapy and Adjunctive Use of Corticosteroids +

    +
    +
    +
    + + + + + + + + + + +
    +
    + + + + + + + + + + + + + + + + +
    Length of therapy6 months
    CorticosteroidsNot recommended
    Additional management considerations + Pursue microbiologic proof of diagnosis prior to starting Rx +
    + + + + + + + + + + + + + + + + +
    Length of therapy6 to 9 months
    CorticosteroidsNot recommended
    Additional management considerationsExtend to 12 months if hardware is present
    + + + + + + + + + + + + + + + + +
    Length of therapy6 to 9 months
    Corticosteroids + Not recommended for TB rx but may be indicated for cord + compression +
    Additional management considerations + Most spine infection can be cured with medical Rx. Surgery + indicated for relief of cord compression, progressive disease + despite medical therapy, instability of the spine. +
    + + + + + + + + + + + + + + + + + + + + + + + + +
    Length of therapy9 to 12 months
    CorticosteroidsStrongly recommended
    Steroid Dosing for Adults + Adults ≥ 25kg
    + 12 mg/day of
    + dexamethasone x 3 weeks
    + followed by 3-week taper +
    Steroid Dosing for Children + Children ≥ 25kg
    + 12 mg/day of
    + dexamethasone x 3 weeks
    + followed by 3-week taper

    + Children < 25kg
    + 8 mg/day of
    + dexamethasone for 3 weeks
    + followed by 3-week taper +
    Additional management considerations + Most spine infection can be cured with medical Rx. Surgery + indicated for relief of cord compression, progressive disease + despite medical therapy, instability of the spine. +
    + + + + + + + + + + + + + + + + +
    Length of therapy9-12 months
    CorticosteroidsStrongly recommended
    Additional management considerations + Negative CSF culture or PCR test does NOT exclude this diagnosis +

    Follow CSF profile for response to therapy

    +
    + + + + + + + + + + + + + + + + +
    Length of therapy6 months
    CorticosteroidsNot recommended
    Additional management considerationsEmpyema may require decortication
    + + + + + + + + + + + + + + + + +
    Length of therapy6 months
    CorticosteroidsNO LONGER routinely RECOMMENDED
    Additional management considerations + Consider steroids for patients at highest risk of later + constriction: large pericardial effusions high levels of + inflammatory cells or markers in pericardial fluid those with + early signs of constriction +
    + + + + + + + + + + + + + + + + +
    Length of therapy6 months
    CorticosteroidsNot recommended
    Additional management considerations + Obtain cultures from blood, urine and sputum in addition to + clinically apparent sites of disease. +
    + + + + + + + + + + + + + + + +
    Length of therapy6 months
    CorticosteroidsNot recommended
    Additional management considerations
    -

    Table 19. Guidelines for Treatment of Extrapulmonary* Tuberculosis: Length of therapy and Adjunctive Use of - Corticosteroids

    + + + + + + + + + + + + + + + +
    Length of therapy6 months
    CorticosteroidsNot recommended
    Additional management considerations
    - -
    - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
    SiteLength of therapy with standard regimen and normal host (months)CorticosteroidsSteroid dosing A (adults) C (children)Additional management considerations
    Lymph node6Not recommendedPursue microbiologic proof of diagnosis prior to starting Rx
    Bone (non-vertebral) and joint6 to 9Not recommendedExtend to 12 months if hardware is present
    Spine without meningitis6 to 9Not recommended for TB rx but may be indicated for cord compressionMost spine infection can be cured with medical Rx. Surgery indicated for relief of cord - compression, progressive disease despite medical therapy, instability of the spine. -
    Spine with meningitis9 to 12Strongly recommendedA and C >= 25kg: 12 mg/day of dexamethasone x 3 weeks followed by 3- week taper

    C < - 25kg:8 mg /day of dexamethasone for 3 weeks followed by 3- week taper

    CNS tuberculosis including meningitis6 to 9Strongly recommendedNegative CSF culture or PCR test does NOT exclude this diagnosis

    Follow CSF profile for response - to therapy

    Pleural disease6Not recommendedEmpyema may require decortication
    Pericarditis6NO LONGER routinely RECOMMENDEDConsider steroids for patients at highest risk of later constriction: - large pericardial effusions high levels of inflammatory cells or markers in pericardial fluid those - with early signs of constriction -
    Disseminated disease6Not recommendedObtain cultures from blood, urine and sputum in addition to clinically apparent sites of disease. -
    Genitourinary6Not recommended
    Peritoneal6Not recommended
    +

    + ALWAYS EVALUATE for concomitant pulmonary involvement with respiratory + samples for smear and culture (regardless of chest imaging findings). +

    +

    Based on CID 2016:63 (1 October) • Nahid et al

    +
    -

    - 2 mg/kg prednisone daily over three weeks, followed by taper Maximum dose 60 mg
    OR
    - Dexamethasone 0.3-0.6 mg/kg daily over three weeks, followed by taper Round to nearest tablet size (2, 4, 6 mg) Maximum dose 12 mg -

    -
    - - - - + + + + diff --git a/app/src/main/assets/pages/6_pregnancy_and_tb.html b/app/src/main/assets/pages/6_pregnancy_and_tb.html index 3133a22..9eef436 100644 --- a/app/src/main/assets/pages/6_pregnancy_and_tb.html +++ b/app/src/main/assets/pages/6_pregnancy_and_tb.html @@ -20,7 +20,7 @@
    - +

    VI. Pregnancy and TB

    diff --git a/app/src/main/assets/pages/6_pregnancy_and_tb__a__treatment_for_ltbi_and_risk_factors.html b/app/src/main/assets/pages/6_pregnancy_and_tb__a__treatment_for_ltbi_and_risk_factors.html index d4f5a8c..dfa9c02 100644 --- a/app/src/main/assets/pages/6_pregnancy_and_tb__a__treatment_for_ltbi_and_risk_factors.html +++ b/app/src/main/assets/pages/6_pregnancy_and_tb__a__treatment_for_ltbi_and_risk_factors.html @@ -19,7 +19,7 @@
    - +

    VI. Pregnancy and TB

    @@ -28,7 +28,7 @@
    -

    Screening for LTBI

    +

    Screening for LTBI

    Testing asymptomatic patients for latent TB infection (LTBI) during pregnancy is indicated only for pregnant patients with significant risk factors for progression to active TB disease during pregnancy.

    diff --git a/app/src/main/assets/pages/6_pregnancy_and_tb__b__treatment_of_active_tb_in_pregnancy.html b/app/src/main/assets/pages/6_pregnancy_and_tb__b__treatment_of_active_tb_in_pregnancy.html index 1df08d8..60e4a75 100644 --- a/app/src/main/assets/pages/6_pregnancy_and_tb__b__treatment_of_active_tb_in_pregnancy.html +++ b/app/src/main/assets/pages/6_pregnancy_and_tb__b__treatment_of_active_tb_in_pregnancy.html @@ -19,7 +19,7 @@
    - +

    VI. Pregnancy and TB

    @@ -59,115 +59,303 @@ to serve as effective treatment for disease or as treatment of LTBI in a nursing infant.

    -

    Table 20. Use of Anti-TB Medications in Special Situations:
    Pregnancy, Tuberculous Meningitis +

    Table 17. Use of Anti-TB Medications in Special Situations: Pregnancy, Tuberculous Meningitis and Renal Failure

    -
    +
    + +
    +
    + + + + + + + + + + + +
    + + +
    - + - - - - + + - - - - - + + + + + + + +
    DrugSafety in Pregnancy (1)Central Nervous System Penetration (2)Dosage in Renal Insufficiency (3)Safety in PregnancySafe i
    IsoniazidSafe (4)Good (20-100%)No changeCentral Nervous System PenetrationGood (20-100%)
    Dosage in Renal InsufficiencyNo change
    +
    + +
    + + - + - + + + + + + + + +
    RifampinSafety in Pregnancy Safe (isolated reports of malformation)Fair, Inflamed meninges (10- 20%)
    Central Nervous System PenetrationFair, Inflamed meninges (10-20%)
    Dosage in Renal Insufficiency No change
    +
    + +
    + + - - + + + + + + + + + +
    PyrazinamideCaution (1)Safety in PregnancyCaution i
    Central Nervous System Penetration Good (75-100%)
    Dosage in Renal Insufficiency Decrease dose/ Increase interval
    +
    + +
    + + - + + + + + + + + +
    EthambutolSafety in Pregnancy Safe
    Central Nervous System Penetration Inflamed meninges only (4-64%)
    Dosage in Renal Insufficiency Decrease dose/ Increase interval
    +
    + +
    + + - + - - - + + + + + + + + +
    Aminoglycosides (Streptomycin, Kanamycin, Amikacin)Safety in Pregnancy AvoidPoor (5)Decrease dose/ Increase interval (6)
    CapreomycinCentral Nervous System PenetrationPoor i
    Dosage in Renal InsufficiencyDecrease dose/ Increase interval i
    +
    + +
    + + + + + + + - - + + + + +
    Safety in Pregnancy Avoid
    Central Nervous System Penetration PoorDecrease dose/ Increase interval (6)
    Levofloxacin, Moxifloxacin GatifloxacinDosage in Renal InsufficiencyDecrease dose/ Increase interval i
    +
    + +
    + + + + + + + - - + + + + +
    Safety in Pregnancy Do not use
    Central Nervous System Penetration Fair (5-10%) Inflamed meninges (50-90%)Decrease dose/ Increase interval (7)
    EthionamideDosage in Renal InsufficiencyDecrease dose/ Increase interval i
    +
    + +
    + + + + + + + + + + + +
    Safety in Pregnancy Avoid
    Central Nervous System Penetration Good (100%)
    Dosage in Renal Insufficiency No change
    +
    + +
    + + - + + + + + + + + +
    CycloserineSafety in Pregnancy Avoid
    Central Nervous System Penetration Good (50-100%)
    Dosage in Renal Insufficiency Decrease dose/ Increase interval
    +
    + +
    + + - + - + + + + + + + + +
    Para-amino-silicylic acidSafety in Pregnancy SafeInflamed meninges - only (50-100%) -
    Central Nervous System PenetrationInflamed meninges only (50-100%)
    Dosage in Renal Insufficiency Incomplete data
    +
    + +
    + + - + + + + + + + -
    ClofazimineSafety in Pregnancy Avoid
    Central Nervous System Penetration Unknown
    Dosage in Renal Insufficiency Probably no change
    - -

    Safe: Drug has not been demonstrated to have teratogenic effects.

    -

    Avoid: Limited data on safety or for aminoglycosides associated with hearing impairment and/or - other toxicity.

    -

    Do Not Use: Associated with premature labor, congenital malformations or teratogenicity.

    -

    NOTES: Table 20 Special Situations

    - -

    (1) As with all medications given during pregnancy, anti-TB drugs should be used with caution. The risk of TB to - the fetus far outweighs the risk of medications. Pregnant patients with active TB should be treated. Data are limited - on the safety of some anti-TB drugs during pregnancy. Table 20 presents a consensus of published data and recommendations. - Although detailed teratogenic data is not available, PZA can probably be used safely for pregnant patients. Concentrations - of anti-TB drugs in breast milk are low; treatment with these medications is not a contraindication to breastfeeding. - Conversely, medication present in breast milk is not sufficient to prevent or treat TB in the newborn. Consult a - medical expert when treating a pregnant patient who has TB. For treatment of LTBI, most authorities recommend beginning - INH 3 months after delivery (as discussed in the text), unless the woman is at high risk for progression to active TB (e.g., - recent infection as evidenced by being a close contact of an infectious TB case, recent TST or IGRA conversion, HIV-infected with CD4<350).

    -

    (2) Steroid treatment appears to improve outcome in TB meningitis, particularly in patients with altered mental - status.

    -

    (3) If possible, monitor serum drug levels of patients with renal insufficiency. See page 71 for dosage.

    -

    (4) Supplement with pyridoxine (Vitamin B6) during pregnancy.

    -

    (5) Has been used intrathecally; efficacy not documented.

    -

    (6) Avoid aminoglycosides and capreomycin in patients with reversible renal damage, if possible.

    -

    (7) Fluoroquinolones may accumulate in renal failure and are poorly removed by dialysis. Dose adjustment indicated. -

    + + +
    + +
      +
    • Safe: Drug has not been demonstrated to have teratogenic effects.
      • +
    • Avoid: Limited data on safety or for aminoglycosides associated with hearing impairment and/or other toxicity.
      • +
    • Do Not Use: Associated with premature labor, congenital malformations or teratogenicity.
      • +
    + diff --git a/app/src/main/assets/pages/7_childhood_tuberculosis.html b/app/src/main/assets/pages/7_childhood_tuberculosis.html index 099dfaa..258a740 100644 --- a/app/src/main/assets/pages/7_childhood_tuberculosis.html +++ b/app/src/main/assets/pages/7_childhood_tuberculosis.html @@ -20,7 +20,7 @@
    - +

    VII. Childhood Tuberculosis

    diff --git a/app/src/main/assets/pages/7_childhood_tuberculosis__a__management_considerations.html b/app/src/main/assets/pages/7_childhood_tuberculosis__a__management_considerations.html index 5dc8b24..ec047c2 100644 --- a/app/src/main/assets/pages/7_childhood_tuberculosis__a__management_considerations.html +++ b/app/src/main/assets/pages/7_childhood_tuberculosis__a__management_considerations.html @@ -19,7 +19,7 @@
    - +

    VII. Childhood Tuberculosis

    diff --git a/app/src/main/assets/pages/8_tuberculosis_and_long-term_care_facilities.html b/app/src/main/assets/pages/8_tuberculosis_and_long-term_care_facilities.html deleted file mode 100644 index 5e333a5..0000000 --- a/app/src/main/assets/pages/8_tuberculosis_and_long-term_care_facilities.html +++ /dev/null @@ -1,73 +0,0 @@ - - - - - - - - Tuberculosis and Long-Term Care Facilities - - - - - - - - -
    -
    -
    -
    -
    - -
    -

    VIII. Tuberculosis and Long-Term Care Facilities

    -
    -

    Last Updated June 2024

    -
    -
    -
    -

    - TB remains a problem in older individuals who may have been infected many years ago and did not develop active - disease at the time. Also, there is increasing documentation of outbreaks of TB occurring in nursing home - residents when a patient with TB disease infects a population of older people who are newly exposed to that - case.

    -

    - TB control in nursing homes and long-term care facilities must begin with a careful assessment of TB status upon - admission, including a diagnostic test for LTBI (TST or IGRA). For those with a positive diagnostic test for - LTBI, an assessment and chest x-ray should be performed as described above to exclude active TB disease.

    -

    - Since people over 50 years old may have diminished skin test reactivity, the two-step technique (see Two-Step Testing) of - tuberculin skin testing is recommended upon admission to the nursing home if the TST is the diagnostic test - being performed to screen for LTBI. A “booster effect” with the TST has been noted in elderly persons in whom - the delayed type hypersensitivity (DTH) reaction to tuberculin may have waned over the years. In these - situations, an initial tuberculin skin test may demonstrate a negative reaction, but it boosts the immune system - so that subsequent tuberculin skin tests may be increased in size and may be interpreted as positive. This - “boosted” response is considered as the valid baseline for the individual and thought to represent latent TB - infection (after active disease is excluded).

    -

    - Residents of nursing homes or long-term care facilities whose baseline two-step skin tests are negative (or - whose baseline IGRA is negative if the IGRA is being used to screen for LTBI) on admission should have repeat - testing performed when an exposure to a case of potentially infectious TB has occurred.

    -
      -
    • Any person who converts a TST or IGRA from negative to positive should be considered for - treatment of LTBI after active TB is ruled out (by chest x-ray at a minimum and sputum specimen if - indicated). -
      • -
    • Any resident with symptoms of TB regardless of TST (or IGRA) results should have a chest x-ray - performed to evaluate for active TB disease. -
      • -
    • Treatment of active TB disease (Class III) is the same as that used for younger adults.
      • -
    -

    - Employees of nursing homes or long-term care facilities should have two-step tuberculin testing when they start - to work in the nursing home if the TST is used for testing of health care workers (if they have not had a TST in - the year prior to initiating employment). The frequency of subsequent testing of healthcare workers is - described on page 102. Employees who are TST (or IGRA) positive at baseline should be evaluated for treatment of - LTBI (see pages 25—27). In addition, those with a recent TST conversion should be strongly encouraged to take - treatment for LTBI after active TB is excluded. Routine annual symptom screening for previously positive TST - employees is recommended instead of an annual CXR.

    -
    - - - diff --git a/app/src/main/assets/pages/9_bcg_vaccination.html b/app/src/main/assets/pages/9_bcg_vaccination.html index 6b38d5c..a068976 100644 --- a/app/src/main/assets/pages/9_bcg_vaccination.html +++ b/app/src/main/assets/pages/9_bcg_vaccination.html @@ -30,36 +30,36 @@

    Bacille Calmette-Guerin (BCG) vaccine is one of the most commonly used vaccines in the world and is given in the vast majority of low- and middle-income countries.

    - -

    BCG is recommended in higher TB incidence areas because + +

    BCG is recommended in higher TB incidence areas because it has a documented protective effect against TB meningitis and disseminated TB in young children. It does not prevent primary infection and, more importantly, does not prevent reactivation of latent pulmonary infection, the principal source of bacillary spread in the community. -

    -

    The impact of BCG vaccination on +

    +

    The impact of BCG vaccination on transmission of M. tuberculosis is therefore very limited (or there is no impact). BCG has not impacted the global epidemiology of TB. Because of variable efficacy, BCG is NOT recommended for use in the U.S. - +

    BCG is not a contraindication to a TST but as noted there can be cross reactions between BCG and the TST. The primary advantage of IGRAs is that they do not cross react with BCG. Interpretation of a tuberculin skin test reaction is not changed for patients who have received BCG.

    - + A reaction of > 10 mm (> 5mm in HIV-infected persons) of induration should be considered infection with M. tuberculosis because:⌃
    -
      -
    • Conversion rates after BCG vaccination are not 100%;
      • -
    • The mean reaction size among BCG vaccines are often less than 10 mm (a large reaction is more - likely to be due to infection with M. tuberculosis than BCG vaccination); -
      • -
    • Tuberculin sensitivity tends to wane considerably after BCG vaccination; and,
      • -
    • BCG is usually given in high TB incidence countries, so assume that the - reaction is from infection, not vaccination. -
      • -
    +
      +
    • Conversion rates after BCG vaccination are not 100%;
      • +
    • The mean reaction size among BCG vaccines are often less than 10 mm (a large reaction is more + likely to be due to infection with M. tuberculosis than BCG vaccination); +
      • +
    • Tuberculin sensitivity tends to wane considerably after BCG vaccination; and,
      • +
    • BCG is usually given in high TB incidence countries, so assume that the + reaction is from infection, not vaccination. +
      • +

    Since many BCG-vaccinated persons come from areas of high TB incidence, it is important that persons with a diff --git a/app/src/main/assets/pages/fig1_factors_to_be_considered.html b/app/src/main/assets/pages/fig1_factors_to_be_considered.html index 3e65d8b..8367457 100644 --- a/app/src/main/assets/pages/fig1_factors_to_be_considered.html +++ b/app/src/main/assets/pages/fig1_factors_to_be_considered.html @@ -17,7 +17,7 @@

    - +

    Factors to be considered in deciding to initiate treatment empirically for active tuberculosis (TB) (prior to microbiologic confirmation)

    diff --git a/app/src/main/assets/pages/georgia_tb_privacy_policy.html b/app/src/main/assets/pages/georgia_tb_privacy_policy.html new file mode 100644 index 0000000..0faa8cd --- /dev/null +++ b/app/src/main/assets/pages/georgia_tb_privacy_policy.html @@ -0,0 +1,87 @@ + + +
    +
    PRIVACY NOTICE

    Last updated March 08, 2021



    Thank you for choosing to be part of our community at Georgia Clinical & Translational Science Alliance ("Company," "we," "us," or "our"). We are committed to protecting your personal information and your right to privacy. If you have any questions or concerns about this privacy notice or our practices with regard to your personal information, please contact us at morgan.greenleaf@emory.edu.

    This privacy notice describes how we might use your information if you:
    • Download and use our mobile application — Georgia TB Reference Guide
    • Engage with us in other related ways ― including any sales, marketing, or events
    In this privacy notice, if we refer to:
    • "App," we are referring to any application of ours that references or links to this policy, including any listed above
    • "Services," we are referring to our App, and other related services, including any sales, marketing, or events
    The purpose of this privacy notice is to explain to you in the clearest way possible what information we collect, how we use it, and what rights you have in relation to it. If there are any terms in this privacy notice that you do not agree with, please discontinue use of our Services immediately.

    Please read this privacy notice carefully, as it will help you understand what we do with the information that we collect.

    TABLE OF CONTENTS


    1. WHAT INFORMATION DO WE COLLECT?

    Personal information you disclose to us

    In Short: We collect personal information that you provide to us.

    We collect personal information that you voluntarily provide to us when you express an interest in obtaining information about us or our products and Services, when you participate in activities on the App or otherwise when you contact us.

    The personal information that we collect depends on the context of your interactions with us and the App, the choices you make and the products and features you use. The personal information we collect may include the following:

    All personal information that you provide to us must be true, complete and accurate, and you must notify us of any changes to such personal information.

    Information automatically collected

    In Short: Some information — such as your Internet Protocol (IP) address and/or browser and device characteristics — is collected automatically when you visit our App.

    We automatically collect certain information when you visit, use or navigate the App. This information does not reveal your specific identity (like your name or contact information) but may include device and usage information, such as your IP address, browser and device characteristics, operating system, language preferences, referring URLs, device name, country, location, information about how and when you use our App and other technical information. This information is primarily needed to maintain the security and operation of our App, and for our internal analytics and reporting purposes.

    The information we collect includes:
    • Log and Usage Data. Log and usage data is service-related, diagnostic, usage and performance information our servers automatically collect when you access or use our App and which we record in log files. Depending on how you interact with us, this log data may include your IP address, device information, browser type and settings and information about your activity in the App (such as the date/time stamps associated with your usage, pages and files viewed, searches and other actions you take such as which features you use), device event information (such as system activity, error reports (sometimes called 'crash dumps') and hardware settings).
    • Device Data. We collect device data such as information about your computer, phone, tablet or other device you use to access the App. Depending on the device used, this device data may include information such as your IP address (or proxy server), device and application identification numbers, location, browser type, hardware model Internet service provider and/or mobile carrier, operating system and system configuration information.
    • Location Data. We collect location data such as information about your device's location, which can be either precise or imprecise. How much information we collect depends on the type and settings of the device you use to access the App. For example, we may use GPS and other technologies to collect geolocation data that tells us your current location (based on your IP address). You can opt out of allowing us to collect this information either by refusing access to the information or by disabling your Location setting on your device. Note however, if you choose to opt out, you may not be able to use certain aspects of the Services.

    Information collected through our App

    In Short: We collect information regarding your mobile device, push notifications, when you use our App.

    If you use our App, we also collect the following information:
    • Mobile Device Access. We may request access or permission to certain features from your mobile device, including your mobile device's calendar, microphone, and other features. If you wish to change our access or permissions, you may do so in your device's settings.
    • Mobile Device Data. We automatically collect device information (such as your mobile device ID, model and manufacturer), operating system, version information and system configuration information, device and application identification numbers, browser type and version, hardware model Internet service provider and/or mobile carrier, and Internet Protocol (IP) address (or proxy server). If you are using our App, we may also collect information about the phone network associated with your mobile device, your mobile device’s operating system or platform, the type of mobile device you use, your mobile device’s unique device ID and information about the features of our App you accessed.
    • Push Notifications. We may request to send you push notifications regarding your account or certain features of the App. If you wish to opt-out from receiving these types of communications, you may turn them off in your device's settings.
    This information is primarily needed to maintain the security and operation of our App, for troubleshooting and for our internal analytics and reporting purposes.

    2. HOW DO WE USE YOUR INFORMATION?

    In Short: We process your information for purposes based on legitimate business interests, the fulfillment of our contract with you, compliance with our legal obligations, and/or your consent.

    We use personal information collected via our App for a variety of business purposes described below. We process your personal information for these purposes in reliance on our legitimate business interests, in order to enter into or perform a contract with you, with your consent, and/or for compliance with our legal obligations. We indicate the specific processing grounds we rely on next to each purpose listed below.

    We use the information we collect or receive:

    • For other business purposes. We may use your information for other business purposes, such as data analysis, identifying usage trends, determining the effectiveness of our promotional campaigns and to evaluate and improve our App, products, marketing and your experience. We may use and store this information in aggregated and anonymized form so that it is not associated with individual end users and does not include personal information.
    • Research

    3. WILL YOUR INFORMATION BE SHARED WITH ANYONE?

    In Short: We only share information with your consent, to comply with laws, to provide you with services, to protect your rights, or to fulfill business obligations.

    We may process or share your data that we hold based on the following legal basis:
    • Consent: We may process your data if you have given us specific consent to use your personal information for a specific purpose.
    • Legitimate Interests: We may process your data when it is reasonably necessary to achieve our legitimate business interests.
    • Performance of a Contract: Where we have entered into a contract with you, we may process your personal information to fulfill the terms of our contract.
    • Legal Obligations: We may disclose your information where we are legally required to do so in order to comply with applicable law, governmental requests, a judicial proceeding, court order, or legal process, such as in response to a court order or a subpoena (including in response to public authorities to meet national security or law enforcement requirements).
    • Vital Interests: We may disclose your information where we believe it is necessary to investigate, prevent, or take action regarding potential violations of our policies, suspected fraud, situations involving potential threats to the safety of any person and illegal activities, or as evidence in litigation in which we are involved.
    More specifically, we may need to process your data or share your personal information in the following situations:
    • Business Transfers. We may share or transfer your information in connection with, or during negotiations of, any merger, sale of company assets, financing, or acquisition of all or a portion of our business to another company.
    • Affiliates. We may share your information with our affiliates, in which case we will require those affiliates to honor this privacy notice. Affiliates include our parent company and any subsidiaries, joint venture partners or other companies that we control or that are under common control with us.
    • Business Partners. We may share your information with our business partners to offer you certain products, services or promotions.

    4. HOW LONG DO WE KEEP YOUR INFORMATION?

    In Short: We keep your information for as long as necessary to fulfill the purposes outlined in this privacy notice unless otherwise required by law.

    We will only keep your personal information for as long as it is necessary for the purposes set out in this privacy notice, unless a longer retention period is required or permitted by law (such as tax, accounting or other legal requirements). No purpose in this notice will require us keeping your personal information for longer than 2 years.

    When we have no ongoing legitimate business need to process your personal information, we will either delete or anonymize such information, or, if this is not possible (for example, because your personal information has been stored in backup archives), then we will securely store your personal information and isolate it from any further processing until deletion is possible.

    5. HOW DO WE KEEP YOUR INFORMATION SAFE?

    In Short: We aim to protect your personal information through a system of organizational and technical security measures.

    We have implemented appropriate technical and organizational security measures designed to protect the security of any personal information we process. However, despite our safeguards and efforts to secure your information, no electronic transmission over the Internet or information storage technology can be guaranteed to be 100% secure, so we cannot promise or guarantee that hackers, cybercriminals, or other unauthorized third parties will not be able to defeat our security, and improperly collect, access, steal, or modify your information. Although we will do our best to protect your personal information, transmission of personal information to and from our App is at your own risk. You should only access the App within a secure environment.

    6. DO WE COLLECT INFORMATION FROM MINORS?

    In Short: We do not knowingly collect data from or market to children under 18 years of age.

    We do not knowingly solicit data from or market to children under 18 years of age. By using the App, you represent that you are at least 18 or that you are the parent or guardian of such a minor and consent to such minor dependent’s use of the App. If we learn that personal information from users less than 18 years of age has been collected, we will deactivate the account and take reasonable measures to promptly delete such data from our records. If you become aware of any data we may have collected from children under age 18, please contact us at morgan.greenleaf@emory.edu.

    7. WHAT ARE YOUR PRIVACY RIGHTS?

    In Short: You may review, change, or terminate your account at any time.
    If you are a resident in the EEA or UK and you believe we are unlawfully processing your personal information, you also have the right to complain to your local data protection supervisory authority. You can find their contact details here: https://ec.europa.eu/justice/data-protection/bodies/authorities/index_en.htm.

    If you are a resident in Switzerland, the contact details for the data protection authorities are available here: https://www.edoeb.admin.ch/edoeb/en/home.html.

    8. CONTROLS FOR DO-NOT-TRACK FEATURES

    Most web browsers and some mobile operating systems and mobile applications include a Do-Not-Track ("DNT") feature or setting you can activate to signal your privacy preference not to have data about your online browsing activities monitored and collected. At this stage no uniform technology standard for recognizing and implementing DNT signals has been finalized. As such, we do not currently respond to DNT browser signals or any other mechanism that automatically communicates your choice not to be tracked online. If a standard for online tracking is adopted that we must follow in the future, we will inform you about that practice in a revised version of this privacy notice.

    9. DO CALIFORNIA RESIDENTS HAVE SPECIFIC PRIVACY RIGHTS?

    In Short: Yes, if you are a resident of California, you are granted specific rights regarding access to your personal information.

    California Civil Code Section 1798.83, also known as the "Shine The Light" law, permits our users who are California residents to request and obtain from us, once a year and free of charge, information about categories of personal information (if any) we disclosed to third parties for direct marketing purposes and the names and addresses of all third parties with which we shared personal information in the immediately preceding calendar year. If you are a California resident and would like to make such a request, please submit your request in writing to us using the contact information provided below.

    If you are under 18 years of age, reside in California, and have a registered account with the App, you have the right to request removal of unwanted data that you publicly post on the App. To request removal of such data, please contact us using the contact information provided below, and include the email address associated with your account and a statement that you reside in California. We will make sure the data is not publicly displayed on the App, but please be aware that the data may not be completely or comprehensively removed from all our systems (e.g. backups, etc.).

    10. DO WE MAKE UPDATES TO THIS NOTICE?

    In Short: Yes, we will update this notice as necessary to stay compliant with relevant laws.

    We may update this privacy notice from time to time. The updated version will be indicated by an updated "Revised" date and the updated version will be effective as soon as it is accessible. If we make material changes to this privacy notice, we may notify you either by prominently posting a notice of such changes or by directly sending you a notification. We encourage you to review this privacy notice frequently to be informed of how we are protecting your information.

    11. HOW CAN YOU CONTACT US ABOUT THIS NOTICE?

    If you have questions or comments about this notice, you may email us at morgan.greenleaf@emory.edu or by post to:

    Georgia Clinical & Translational Science Alliance
    1440 Clifton Rd NE #134
    Atlanta, GA 30322
    United States

    12. HOW CAN YOU REVIEW, UPDATE, OR DELETE THE DATA WE COLLECT FROM YOU?

    Based on the applicable laws of your country, you may have the right to request access to the personal information we collect from you, change that information, or delete it in some circumstances. To request to review, update, or delete your personal information, please submit a request form by clicking here.
    +
    +
    This privacy policy was created using Termly's Privacy Policy Generator.
    diff --git a/app/src/main/assets/pages/hello_and_welcome_clinical_statement.html b/app/src/main/assets/pages/hello_and_welcome_clinical_statement.html new file mode 100644 index 0000000..69daced --- /dev/null +++ b/app/src/main/assets/pages/hello_and_welcome_clinical_statement.html @@ -0,0 +1,58 @@ + + + + + + + + Hello and Welcome Clinical Statement + + + + + + + + +
    +

    + Dear Clinician:

    + + The Georgia TB Reference Guide responds to clinicians’ questions about tuberculosis infection, disease, and prevention and control. The standards and guidelines are based on the work and recommendations of the American Thoracic Society (ATS), the Centers for Disease Control and Prevention (CDC), the Infectious Disease Society of America (IDSA), Emory University, and the World Health Organization (WHO). The Guide also provides guidance from the Georgia Department of Public Health (DPH) TB Program and contact information for District TB Coordinators. This updated edition of the Guide contains updated recommendations on the treatment of latent TB infection (LTBI) and treatment of active TB disease and an updated format inspired by users of the Guide app. + +

    +

    + The treatment of a person with TB always requires a clinician to exercise clinical and professional judgment. These guidelines provide a framework for the diagnosis and treatment of persons with TB infection or active TB disease. +

    +

    This is not an exhaustive review of the subjects covered. It is an accessible reference guide which provides guidance for diagnosis, treatment and prevention of TB. Since guidelines for treating, preventing, and controlling TB continue to evolve, it is appropriate for clinicians to check further for new treatment regimens.

    +

    + The Georgia TB Reference Guide app was redesigned and extensively updated in 2025 based on user feedback and new developments in the field of TB. +

    +

    Detailed information is available from:

    +
  • Your county public health department and the Georgia Department of Public Health (DPH) TB Program (phone: 404-657-2634 or online: https://dph.georgia.gov/health-topics/tuberculosis-tb-prevention-and-control).
    • +

    Sincerely,

    +
    +
    + Henry M. Blumberg, M.D +

    Henry M. Blumberg, M.D. + Emory University

    +
    + +
    + Marcos Schechter, M.D +

    Marcos Schechter, M.D. + Emory University

    +
    + +
    + Susan M. Ray, M.D +

    Susan M. Ray, M.D. + Emory University

    +
    +
    +
    + + + + + diff --git a/app/src/main/assets/pages/main.js b/app/src/main/assets/pages/main.js index 0c499a6..4539c12 100644 --- a/app/src/main/assets/pages/main.js +++ b/app/src/main/assets/pages/main.js @@ -1,77 +1,136 @@ // function to handle tab switching for any table function activateTab(tableContainer, tabIndex) { - if (!tableContainer) return; + if (!tableContainer) return; - tableContainer.querySelectorAll('.tab-button, .tab, .tab, .tab').forEach(tab => { - tab.classList.remove('active-option', 'active-tab'); + tableContainer + .querySelectorAll(".tab-button, .tab, .tab, .tab") + .forEach((tab) => { + tab.classList.remove("active-option", "active-tab"); }); - - tableContainer.querySelectorAll('.option-content, .tab-content, .tab-content, .tab-content').forEach(content => { - content.classList.remove('active-option', 'active-tab'); + + tableContainer + .querySelectorAll( + ".option-content, .tab-content, .tab-content, .tab-content" + ) + .forEach((content) => { + content.classList.remove("active-option", "active-tab"); }); - // Add active class to selected tab and content - const selectedTab = tableContainer.querySelectorAll('.tab-button, .tab, .tab, .tab')[tabIndex]; - const selectedContent = tableContainer.querySelectorAll('.option-content, .tab-content, .tab-content, .tab-content')[tabIndex]; - - if (selectedTab) { - if (selectedTab.classList.contains('tab')) { - selectedTab.classList.add('active-tab'); - } else if (selectedTab.classList.contains('tab-button')) { - selectedTab.classList.add('active-option'); - } else if (selectedTab.classList.contains('tab')) { - selectedTab.classList.add('active-tab'); - } else if (selectedTab.classList.contains('tab')) { - selectedTab.classList.add('active-tab'); - } + // Add active class to selected tab and content + const selectedTab = tableContainer.querySelectorAll( + ".tab-button, .tab, .tab, .tab" + )[tabIndex]; + const selectedContent = tableContainer.querySelectorAll( + ".option-content, .tab-content, .tab-content, .tab-content" + )[tabIndex]; + + if (selectedTab) { + if (selectedTab.classList.contains("tab")) { + selectedTab.classList.add("active-tab"); + } else if (selectedTab.classList.contains("tab-button")) { + selectedTab.classList.add("active-option"); + } else if (selectedTab.classList.contains("tab")) { + selectedTab.classList.add("active-tab"); + } else if (selectedTab.classList.contains("tab")) { + selectedTab.classList.add("active-tab"); } - - if (selectedContent) { - if (selectedContent.classList.contains('tab-content')) { - selectedContent.classList.add('active-tab'); - } else if (selectedContent.classList.contains('option-content')) { - selectedContent.classList.add('active-option'); - } else if (selectedContent.classList.contains('tab-content')) { - selectedContent.classList.add('active-tab'); - } else if (selectedContent.classList.contains('tab-content')) { - selectedContent.classList.add('active-tab'); - } + } + + if (selectedContent) { + if (selectedContent.classList.contains("tab-content")) { + selectedContent.classList.add("active-tab"); + } else if (selectedContent.classList.contains("option-content")) { + selectedContent.classList.add("active-option"); + } else if (selectedContent.classList.contains("tab-content")) { + selectedContent.classList.add("active-tab"); + } else if (selectedContent.classList.contains("tab-content")) { + selectedContent.classList.add("active-tab"); } + } } // Function to handle tab switching with event function handleTabSwitch(event, tabIndex) { - // Get the clicked button from the event - const clickedButton = event.currentTarget; - - const tableContainer = clickedButton.closest('.uk-overflow-auto'); - if (!tableContainer) return; - - // Get all tab buttons in this container - const tabButtons = tableContainer.querySelectorAll('.tab-button, .tab, .tab, .tab'); - - // Find the index of the clicked button within its container - const clickedIndex = Array.from(tabButtons).indexOf(clickedButton); - - // Generate a unique ID for the container if it doesn't have one - if (!tableContainer.id) { - tableContainer.id = 'table-' + Math.random().toString(36).substr(2, 9); - } - - // Switch to the correct tab - activateTab(tableContainer, clickedIndex); + // Get the clicked button from the event + const clickedButton = event.currentTarget; + + const tableContainer = clickedButton.closest(".uk-overflow-auto"); + if (!tableContainer) return; + + // Get all tab buttons in this container + const tabButtons = tableContainer.querySelectorAll( + ".tab-button, .tab, .tab, .tab" + ); + + // Find the index of the clicked button within its container + const clickedIndex = Array.from(tabButtons).indexOf(clickedButton); + + // Generate a unique ID for the container if it doesn't have one + if (!tableContainer.id) { + tableContainer.id = "table-" + Math.random().toString(36).substr(2, 9); + } + + // Switch to the correct tab + activateTab(tableContainer, clickedIndex); } function switchTab(tabIndex, event) { - handleTabSwitch(event, tabIndex); + handleTabSwitch(event, tabIndex); } // For Dropdown Togglers function toggleItem(clickedTitle) { - const itemContent = clickedTitle.nextElementSibling; - - itemContent.classList.toggle('active'); + const itemContent = clickedTitle.nextElementSibling; + + itemContent.classList.toggle("active"); + + const chevronUp = clickedTitle.querySelector(".chevron-up"); + chevronUp.classList.toggle("active"); +} + +document.addEventListener("DOMContentLoaded", function () { + const tooltips = document.querySelectorAll(".info-icon"); + + document.addEventListener("click", function (event) { + if (!event.target.closest(".info-icon")) { + document.querySelectorAll(".info-icon.active").forEach((activeIcon) => { + activeIcon.classList.remove("active"); + }); + } + }); - const chevronUp = clickedTitle.querySelector('.chevron-up'); - chevronUp.classList.toggle('active'); -} \ No newline at end of file + tooltips.forEach(function (icon) { + let tooltip = icon.querySelector(".tooltip"); + if (!tooltip) { + tooltip = document.createElement("div"); + tooltip.className = "tooltip"; + tooltip.textContent = + icon.getAttribute("data-tooltip") || "Additional information"; + + // Get positioning class from data attribute + const positionClass = + icon.getAttribute("data-tooltip-position") || "tooltip-center"; + tooltip.classList.add(positionClass); + + icon.appendChild(tooltip); + } + + let isTooltipVisible = false; + + icon.addEventListener("click", function (event) { + event.stopPropagation(); + + document.querySelectorAll(".info-icon.active").forEach((activeIcon) => { + if (activeIcon !== icon) { + activeIcon.classList.remove("active"); + const otherTooltip = activeIcon.querySelector(".tooltip"); + if (otherTooltip) otherTooltip.style.display = "none"; + } + }); + + isTooltipVisible = !this.classList.contains("active"); + this.classList.toggle("active"); + tooltip.style.display = isTooltipVisible ? "block" : "none"; + }); + }); +}); diff --git a/app/src/main/assets/pages/table_13_antituberculosis_antibiotics_in_adult_patients_with_renal_impairment.html b/app/src/main/assets/pages/table_10_antituberculosis_antibiotics_in_adult_patients_with_renal_impairment.html similarity index 90% rename from app/src/main/assets/pages/table_13_antituberculosis_antibiotics_in_adult_patients_with_renal_impairment.html rename to app/src/main/assets/pages/table_10_antituberculosis_antibiotics_in_adult_patients_with_renal_impairment.html index 077e621..a0710b3 100644 --- a/app/src/main/assets/pages/table_13_antituberculosis_antibiotics_in_adult_patients_with_renal_impairment.html +++ b/app/src/main/assets/pages/table_10_antituberculosis_antibiotics_in_adult_patients_with_renal_impairment.html @@ -16,11 +16,19 @@
    -

    View in chapter → Special Clinical Situations

    -

    Last Updated October 2025

    +
    +
    +
    + +
    +

    10. Antituberculosis Antibiotics in Adult Patients with Renal Impairment

    +
    +

    View in chapter → Special Clinical Situations

    +

    Last Updated October 2025

    +
    + id="table_10_antituberculosis_antibiotics_in_adult_patients_with_renal_impairment">
      • @@ -34,12 +42,7 @@
    -

    - NOTE: Drug adjustments are based on the creatinine clearance (CrCl) which can be estimated as follows:
    - [(140-age in yrs)(Ideal body weight in kg) for men (x 0l85 for women)] / [(72) (serum creatinine, mg/dL)] - Ideal body weight for men: 50 kg + 2.3 kg per inch over 5 feet - Ideal body weight for women: 45.5 kg + 2.3 kg per inch over 5 feet -

    +

    Important Note i

    @@ -236,7 +239,7 @@ - + @@ -270,4 +273,5 @@ + diff --git a/app/src/main/assets/pages/table_10_pediatric_dosages_rifampin_in_children_(birth_to_15_years).html b/app/src/main/assets/pages/table_10_pediatric_dosages_rifampin_in_children_(birth_to_15_years).html deleted file mode 100644 index 35b71a7..0000000 --- a/app/src/main/assets/pages/table_10_pediatric_dosages_rifampin_in_children_(birth_to_15_years).html +++ /dev/null @@ -1,65 +0,0 @@ - - - - - - - - GA TB Reference Guide - - - - - - - - -
    -

    View in chapter → Special Clinical Situations

    -

    Last Updated October 2025

    -
    -
    -
    CrCl <30 or Hemodialysis600 mg/dose thrice weeklyUD
    Peritoneal Dialysis
    - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
    Child's Weight (lbs)Child's Weight (kg)Daily Dose (mg) 10-20 mg/kg
    Child's Weight (lbs)Child's Weight (kg)Dose (mg) 10-20 mg/kg
    15 - 32 7 - 14.5150 mg
    33 - 48.515 - 22300 mg
    49 - 6522.5 - 29.5450 mg
    66 +30 +600 mg
    - - -
    -
    - - - - diff --git a/app/src/main/assets/pages/table_14_antituberculosis_medications_which_may_be_used_for_patients_who_have_contraindications_to_or_intolerance.html b/app/src/main/assets/pages/table_11_antituberculosis_medications_which_may_be_used_for_patients_who_have_contraindications_to_or_intolerance.html similarity index 51% rename from app/src/main/assets/pages/table_14_antituberculosis_medications_which_may_be_used_for_patients_who_have_contraindications_to_or_intolerance.html rename to app/src/main/assets/pages/table_11_antituberculosis_medications_which_may_be_used_for_patients_who_have_contraindications_to_or_intolerance.html index bc3486a..8330af5 100644 --- a/app/src/main/assets/pages/table_14_antituberculosis_medications_which_may_be_used_for_patients_who_have_contraindications_to_or_intolerance.html +++ b/app/src/main/assets/pages/table_11_antituberculosis_medications_which_may_be_used_for_patients_who_have_contraindications_to_or_intolerance.html @@ -16,11 +16,19 @@
    -

    View in chapter → Special Clinical Situations

    -

    Last Updated October 2025

    +
    +
    +
    + +
    +

    11. Antituberculosis Medications for Patients who have Contraindications to or Intolerance of First Line Agents or require IV Therapy during Acute or Critical Illness.

    +
    +

    View in chapter → Special Clinical Situations

    +

    Last Updated October 2025

    +
    + id="table_11_antituberculosis_medications_which_may_be_used_for_patients_who_have_contraindications_to_or_intolerance">
      @@ -40,15 +48,21 @@ - + - + + + + + @@ -56,8 +70,9 @@
      Dosing (A for adults, C for children)Dosing - A: 750 mg daily
      - C: 15 – 20 mg/kg daily
      - Max dose: 750 mg + Adults
      + 750 mg

      + Children
      + 15 - 20 mg

      + Max dose
      750 mg
      Adverse ReactionsFrequencyDaily
      Adverse Reactions GI upset, dizziness, hypersensitivity, Headaches, QT prolongation, tendon rupture (rare), arthralgia, increased risk for aortic dissection/rupture, hypo/hyperglycemia
      +

      Additional Notes:

      - Expert consultation is advised before use; agent is not approved for children less than 18 years of age. + Dosing above for persons with CrCL > 50 mL/min. For persons with renal impairment, see Table 13. Expert consultation is advised before use; agent is not approved for children less than 18 years of age.

    @@ -65,13 +80,19 @@ - + + + + +
    Dosing (A for adults, C for children)Dosing - A: 10-15 mg/kg
    - C: No established dose
    - Max dose: 400 mg + Adults
    + 10 - 15 mg/kg

    + Children
    + No established dose

    + Max dose
    450 mg
    FrequencyDaily
    Adverse Reactions @@ -81,9 +102,8 @@
    -

    - Expert consultation is advised before use; agent is not approved for children less than 18 years of age. -

    +

    Additional Notes:

    +

    Expert consultation is advised before use; agent is not approved for children less than 18 years of age.

    @@ -91,22 +111,28 @@ Dosing (A for adults, C for children) + - A: 600 mg (once daily)
    - C: - Children < 12 years: -
      -
    • 5 – 10 kg: 15 mg/kg once daily
      • -
    • 10 – 23 kg: 12 mg/kg once daily
      • -
    • >23 kg: 10 mg/kg once daily
      • -
    - Children ≥12 years: + Adults
    + 600 mg

    + + Children < 12 years
      -
    • 10 mg/kg once daily
      • +
    • 5 – 10 kg: 15 mg/kg
      • +
    • 10 – 23 kg: 12 mg/kg
      • +
    • >23 kg: 10 mg/kg
    - Max dose: 600 mg + + Childrenl ≥ 12 years
    + 10 mg/kg

    + + Max dose
    600 mg + + Frequency + Daily + Adverse Reactions @@ -120,16 +146,19 @@
    - - + + + + + +
    Dosing (A for adults, C for children)
    Dosing - A: 10 to 15 mg/kg/day
    - 5-7 days per week or 3 times per week

    - - C: 15 to 30 mg/kg/day (max dose 1 gram)
    - 5-7 days per week or 3 times per week + Adults
    + 10 to 15 mg/kg/day

    + Children
    + 15 to 30 mg/kg/day (max dose 1 gram)
    Frequency5-7 days per week or 3 times per week
    Adverse Reactions @@ -138,6 +167,9 @@
    + +

    Additional Notes:

    +

    Dosing above for persons with CrCL > 50 mL/min. For persons with renal impairment, see Table 13.

    diff --git a/app/src/main/assets/pages/table_11_pediatric_dosages_ethambutol_in_children_(birth_to_15_years).html b/app/src/main/assets/pages/table_11_pediatric_dosages_ethambutol_in_children_(birth_to_15_years).html deleted file mode 100644 index 537fb0f..0000000 --- a/app/src/main/assets/pages/table_11_pediatric_dosages_ethambutol_in_children_(birth_to_15_years).html +++ /dev/null @@ -1,90 +0,0 @@ - - - - - - - - GA TB Reference Guide - - - - - - - - -
    -

    View in chapter → Special Clinical Situations

    -

    Last Updated October 2025

    -
    -
    - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
    Child’s Weight (lbs)Child’s Weight (kg)Daily Dose (mg) 15 – 25 mg/kg
    11 – 155 – 7100 mg
    16 – 318 – 14200 mg
    32 – 4415 – 20300 mg
    45 – 5521 – 25400 mg
    56 – 6726 – 30.5500 mg
    68 – 7631 – 34.5600 mg
    77 – 8735 – 39.5700 mg
    88 – 12140 – 55800 mg
    122 – 16556 – 751200 mg
    166 +76 +1600 mg
    -

    - The maximum recommendation for ethambutol is 1 g daily. -

    -
    -
    - - - - diff --git a/app/src/main/assets/pages/table_12_clinical_situations_for_which_standard_therapy_cannot_be_given_or_is_not_well_tolerated.html b/app/src/main/assets/pages/table_12_clinical_situations_for_which_standard_therapy_cannot_be_given_or_is_not_well_tolerated.html new file mode 100644 index 0000000..adcb3ca --- /dev/null +++ b/app/src/main/assets/pages/table_12_clinical_situations_for_which_standard_therapy_cannot_be_given_or_is_not_well_tolerated.html @@ -0,0 +1,242 @@ + + + + + + + + GA TB Reference Guide + + + + + + + +
    +
    +
    +
    + +
    +

    12. Clinical Situations for which Standard Therapy cannot be given or is not well-tolerated or may not be effective: Potential Alternative Regimens (Dosing and/or Drugs)

    +
    +

    View in chapter → Special Clinical Situations

    +

    Last Updated October 2025

    +
    +
    +
    +
    +
    + + + + + + + +
    + +
    + + + + + + + + + + + + + + + +
    Concerns RaisedPoor gut medication absorption
    Regimen +
      +
    • IV rifampin ≥ 10 mg/kg daily
      • +
    • PO pyrazinamide UD
      • +
    • PO ethambutol UD
      • +
    + Consider adding at least two of the following agents. +
      +
    • IV isoniazid UD i
      • +
    • IV levofloxacin or moxifloxacin UD
      • +
    • IV linezolid UD i
      • +
    • IV amikacin UD i
      • +
    +
    Comments +
      +
    • Oral medications are generally poorly bioavailable among critically ill patients.
      • +
    • Patients receiving sedation are unable to report isoniazid or linezolid-induced neuropathies nor aminoglycoside- induced otovestibular toxicity
      • +
    +
    +
    + +
    + + + + + + + + + + + + + + + +
    Concerns RaisedRapidly progressive and often fatal. High plasma levels needed to achieve adequate CNS penetration. + High index of suspicion necessary; microbiological diagnostic tests have low yield.
    Regimen +
      +
    • IV rifampin ≥ 10 mg/kg daily
      • +
    • PO or IV i isoniazid UD
      • +
    • PO pyrazinamide UD PO ethambutol UD (adults)
      • +
    • PO ethionamide (children)
      • +
    +

    Consider adding IV levofloxacin or moxifloxacin UD in lieu of ethambutol, especially if there is concern for isoniazid-resistant TB.

    +
    CommentsRifampin has poor CNS penetration but is an essential drug for meningeal TB treatment. Isoniazid, + pyrazinamide, levofloxacin, and moxifloxacin have excellent CNS penetration. +

    Ethambutol has poor CNS penetration. Early use of fluoroquinolones has been associated with + improved outcomes among patients with isoniazid-resistant meningeal TB

    +
    + +
    + + + + + + + + + + + + + + + +
    Concerns RaisedIncreased risk for pyrazinamide-induced hepatotoxicity
    RegimenCan consider rifampin, isoniazid, and ethambutol without pyrazinamide when drug-susceptibility is + known and/or patient has low burden of disease
    Comments3-drug regimens may increase risk of failure or acquired drug-resistance.
    +
    + +
    + + + + + + + + + + + + + + + +
    Concerns RaisedDisseminated TB is associated with gut edema which decreases po medication bioavailability
    RegimenStandard 4-drug regimen Consider increasing po Rifampin dose (15 to 20 mg/kg daily, minimum 600 mg) + Consider IV rifampin and IV isoniazid i for inpatients.
    CommentsConsider obtaining TB drug levels in ensure po dosing achieves at least minimum levels
    +
    + +
    + + + + + + + + + + + + + + + +
    Concerns RaisedTube feeds may decrease TB drug bioavailability
    RegimenNo change in standard TB regimen
    CommentsHold tube feeds ≤2 hours prior and ≥1 hour after TB drug intake. Longer intervals are needed if quinolone- containing regimens are given with divalent-cation containing tube feeds
    +
    + +
    + + + + + + + + + + + + + + + +
    Concerns RaisedConsider limiting number of hepatotoxic drugs for patients with baseline ALT>3x UNL and/or advanced + liver disease. + Order of hepatotoxicity: PZA>INH>RIF
    Regimen +
      +
    • RIF/INH/EMB +/- FQN
      • +
    • RIF/EMB/FQN +/- LZD or AG
      • +
    • EMB/FQN +/- LZD or AG
      • +
    +
    Comments + Consider baseline liver enzyme elevation could be due to hepatic TB

    + 3-drug regimens may increase risk of failure or acquired drug-resistance. +
    +
    + +
    + + + + + + + + + + + + + + + +
    Concerns RaisedTB drug-induced hepatotoxicity + Stop TB drugs if ALT>3x UNL and patient symptomatic or ALT >5x UNL regardless of symptoms
    RegimenSequential re-introduction of TB drugs once ALT <2x UNL.
    + (1) Rifamycin x 5-7 days
    + (2) Isoniazid x 5-7 days
    + (3) Ethambutol x 5-7 days
    + (4) Need and choice of 4th agent depends on burden of disease and drug-susceptibility pattern. +
    CommentsPyrazinamide is often the culprit and effective regimens can be designed without this drug. + Rifamycins are the drugs most important for sterilizing activity (i.e., cure) in TB treatment. + Consider adding a 4th drug if patient has high burden of disease.
    +
    + +

    Abbreviations: UD, usual dose; UNL, upper normal limit.

    + +

    Additional Notes:
    + These recommendations are meant for patients with known drug-susceptible TB or at low risk for drug- resistant TB

    +
    +
    +
    + + + + + + diff --git a/app/src/main/assets/pages/table_12_pediatric_dosages_pyrazinamide_in_children_(birth_to_15_years).html b/app/src/main/assets/pages/table_12_pediatric_dosages_pyrazinamide_in_children_(birth_to_15_years).html deleted file mode 100644 index 4f80b62..0000000 --- a/app/src/main/assets/pages/table_12_pediatric_dosages_pyrazinamide_in_children_(birth_to_15_years).html +++ /dev/null @@ -1,112 +0,0 @@ - - - - - - - - GA TB Reference Guide - - - - - - - - -
    -

    View in chapter → Special Clinical Situations

    -

    Last Updated October 2025

    -
    -
    - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
    Child's Weight (lbs)Child's Weight (kg)Daily Dose (mg) 30-40 mg/kg PO
    13 - 236 - 10.5250 mg
    24 - 2611 - 12250 mg
    27 - 3112.5 - 14500 mg
    32 - 4114.5 - 18.5500 mg
    42 - 4719.0 - 21.5750 mg
    48 - 5422.0 - 24.5750 mg
    55 – 6325 – 28.51000 mg
    64 – 6729 – 30.51000 mg
    68 – 8031 – 36.51250 mg
    81 – 9337 – 42.51500 mg
    94 – 10643 – 48.51750 mg
    107 +49 +2000 mg
    -
    -
    - - - - - - diff --git a/app/src/main/assets/pages/table_13_when_to_start_hiv_therapy.html b/app/src/main/assets/pages/table_13_when_to_start_hiv_therapy.html new file mode 100644 index 0000000..a6c3515 --- /dev/null +++ b/app/src/main/assets/pages/table_13_when_to_start_hiv_therapy.html @@ -0,0 +1,62 @@ + + + + + + + + GA TB Reference Guide + + + + + + + + + +
    +
    +
    +
    + +
    +

    13. When to Start HIV Therapy

    +
    +

    View in chapter → Antiretroviral Therapy (ART) and Treatment of Persons Living with HIV and Active TB

    +

    Last Updated October 2025

    +
    +
    +
    + + + + + + + + + + + + + + + + + + + + + + +
    HHS Panel Recommendations on treatment of Tuberculosis Disease with HIV co-infection: Timing of Antiretroviral Therapy (ART) Initiation relative to TB treatment
    CD4 count and/or clinical status at time of TB diagnosisART Initiation
    < 50 cells/mm³ iwithin 2 weeks of starting TB therapy.
    > 50 cells/mm³ iby 8 to 12 weeks of starting TB therapy
    Pregnant, any CD4 countAs early as feasible
    +

    Above based on guidelines developed by the Department of Health and Human Services (DHHS) Panel on Guidelines for Use of Antiretroviral Agents for Adults and Adolescents and Use of Antiretroviral Drugs in Pregnant Women with HIV Infection and Interventions to Reduce Perinatal Transmission in the United States, last reviewed and updated April 15, 2019
    (https://aidsinfo.nih.gov/guidelines).

    +
    +
    + + + + + diff --git a/app/src/main/assets/pages/table_14_what_to_start_choice_of_tb_therapy_and_antiretroviral_therapy_(art)_when_treating_co-infected_patients.html b/app/src/main/assets/pages/table_14_what_to_start_choice_of_tb_therapy_and_antiretroviral_therapy_(art)_when_treating_co-infected_patients.html new file mode 100644 index 0000000..a26bf2d --- /dev/null +++ b/app/src/main/assets/pages/table_14_what_to_start_choice_of_tb_therapy_and_antiretroviral_therapy_(art)_when_treating_co-infected_patients.html @@ -0,0 +1,251 @@ + + + + + + + + GA TB Reference Guide + + + + + + + + + +
    +
    +
    +
    + +
    +

    14. What to start: Choice of TB Therapy and Antiretroviral Therapy (ART) when treating Co-infected Patients

    +
    +

    View in chapter → Antiretroviral Therapy (ART) and Treatment of Persons Living with HIV and Active TB

    +

    Last Updated June 2024

    +
    +
    +
    +

    + + Principle: Despite Drug Interactions, a Rifamycin (Rifampin or Rifabutin) Should Be Included in TB Regimens for Patients Receiving ART, with Dosage Adjustment if Necessary + +

    + +
    +
      +
      • +
      • +
      • +
    +
    + +
    +

    + + Integrase-based ART regimens. Dolutegravir is the preferred integrase for TB/HIV co-infection treatment. + +

    + +

    1a. Patients receiving rifampin-based TB treatment.

    + + + + + + + + + + + + + + + + + + + +
    PreferredDTG (Tivicay) BID + TDF/FTC (Truvada)
    Alternative +
      +
    • DTG (Tivicay) BID + TAF/FTC (Descovy)
      • +
    • DTG (Tivicay) BID + ABC/3TC
      • +
    +
    FrequencyDaily for both preferred and alternative
    NoteTriumeq is a combination of DTG/ABC/3tc
    + + +

    1b. Patients receiving rifabutin-based TB treatment

    + + + + + + + + + + + + + + + + + + + +
    PreferredDTG (Tivicay) BID + TDF/FTC (Truvada)
    Alternative +
      +
    • DTG (Tivicay) BID + TAF/FTC (Descovy)
      • +
    • DTG/ABC/3TC (Triumeq)
      • +
    +
    FrequencyDaily for both preferred and alternative
    NoteThe FDA does not recommend using TAF with rifampin or rifabutin
    + +

    Abbreviations:

    +
      +
    • NRTIs: nucleoside/-tide reverse transcriptase inhibitors
      • +
    • NNRTIs: non-nucleoside reverse transcriptase inhibitors
      • +
    • PIs: protease inhibitors
      • +
    • /r: boosted with ritonavir
      • +
    • TDF: Tenofovir disoproxil fumarate
      • +
    • TAF: Tenofovir alafenamide
      • +
    • FTC: Emtricitabine
      • +
    • 3TC: Lamivudine
      • +
    • ABC: Abacavir
      • +
    • ATV/r: Atazanavir/ritonavir
      • +
    • DRV/r: Darunavir/ritonavir
      • +
    • DTG: Dolutegravir
      • +
    + +

    Source:

    +
      +
    • Above based on guidelines developed by the Department of Health and Human Services (DHHS) Panel on Guidelines for Use of Antiretroviral Agents for Adults and Adolescents and Use of Antiretroviral Drugs in Pregnant Women living with HIV and Interventions to Reduce
      • +
    • Perinatal Transmission in the United States, last reviewed and updated October 29, 2024 (https://aidsinfo.nih.gov/guidelines).
      • +
    +
    + +
    +

    + + PI-based ART regimens + + (cannot be used with rifampin, must use with dose-adjusted rifabutin) + +

    + +

    2a

    + + + + + + + + + + + + + + + +
    PreferredATV/r + TDF/FTC (Truvada)
    Alternative +
      +
    • ATV/r + TAF/FTC (Descovy)
      • +
    • ATV/r + ABC/3TC
      • +
    +
    FrequencyDaily for both preferred and alternative
    + + +

    2b

    + + + + + + + + + + + + + + + +
    PreferredDRV/r + TDF/FTC (Truvada)
    Alternative +
      +
    • DRV/r + TAF/FTC (Descovy)
      • +
    • DRV/r + ABC/3TC
      • +
    +
    FrequencyDaily for both preferred and alternative
    + +

    Additional Notes:

    +
      +
    • PI’s have high barrier to resistance. However, given rifabutin is given at half-dose when used with PI’s adherence to ART should be closely monitored. Poor adherence to PI’s while on rifabutin increases risk for rifampin resistance.
      • +
    • The FDA does not recommend using TAF with rifampin or rifabutin.
      • +
    • Cobicistat cannot be used with rifabutin.
      • +
    + +

    Abbreviations:

    +
      +
    • NRTIs: nucleoside/-tide reverse transcriptase inhibitors
      • +
    • NNRTIs: non-nucleoside reverse transcriptase inhibitors
      • +
    • PIs: protease inhibitors
      • +
    • /r: boosted with ritonavir
      • +
    • TDF: Tenofovir disoproxil fumarate
      • +
    • TAF: Tenofovir alafenamide
      • +
    • FTC: Emtricitabine
      • +
    • 3TC: Lamivudine
      • +
    • ABC: Abacavir
      • +
    • ATV/r: Atazanavir/ritonavir
      • +
    • DRV/r: Darunavir/ritonavir
      • +
    • DTG: Dolutegravir
      • +
    + +

    Source:

    +
      +
    • Above based on guidelines developed by the Department of Health and Human Services (DHHS) Panel on Guidelines for Use of Antiretroviral Agents for Adults and Adolescents and Use of Antiretroviral Drugs in Pregnant Women living with HIV and Interventions to Reduce
      • +
    • Perinatal Transmission in the United States, last reviewed and updated October 29, 2024 (https://aidsinfo.nih.gov/guidelines).
      • +
    +
    + +
    +

    + + Choice for Pregnant Women living with HIV and with Active TB + +

    + +

    2a

    + + + + + + + +
    Notes +
      +
    • Expert consultation advised.
      • +
    • Options 1a and 1b are currently preferred in pregnancy.
      • +
    +
    + +

    Source:

    +
      +
    • Above based on guidelines developed by the Department of Health and Human Services (DHHS) Panel on Guidelines for Use of Antiretroviral Agents for Adults and Adolescents and Use of Antiretroviral Drugs in Pregnant Women living with HIV and Interventions to Reduce
      • +
    • Perinatal Transmission in the United States, last reviewed and updated October 29, 2024 (https://aidsinfo.nih.gov/guidelines).
      • +
    +
    +
    +
    + + + + + diff --git a/app/src/main/assets/pages/table_15_clinical_situations_for_which_standard_therapy_cannot_be_given_or_is_not_well_tolerated.html b/app/src/main/assets/pages/table_15_clinical_situations_for_which_standard_therapy_cannot_be_given_or_is_not_well_tolerated.html deleted file mode 100644 index b594e97..0000000 --- a/app/src/main/assets/pages/table_15_clinical_situations_for_which_standard_therapy_cannot_be_given_or_is_not_well_tolerated.html +++ /dev/null @@ -1,220 +0,0 @@ - - - - - - - - GA TB Reference Guide - - - - - - - -
    -

    View in chapter → Special Clinical Situations

    -

    Last Updated October 2025

    -
    -
    -
    -
    - - - - - - - -
    - -
    - - - - - - - - - - - - - - - -
    Concerns RaisedPoor gut medication absorption
    Regimen1-IV rifampin ≥ 10 mg/kg daily+
    - 2-PO pyrazinamide UD+
    - 3-PO ethambutol UD+
    - 4-IV isoniazid UD2,3+
    - 5-IV levofloxacin or moxifloxacin UD 4+
    - 6-IV linezolid UD 54+
    - 7-IV amikacin UD5
    CommentsOral medications are generally poorly bioavailable among critically ill patients.

    Patients - receiving sedation are unable to report isoniazid or linezolid-induced neuropathies nor - aminoglycoside- induced otovestibular toxicity

    -
    - -
    - - - - - - - - - - - - - - - -
    Concerns RaisedRapidly progressive and often fatal. High plasma levels needed to achieve adequate CNS penetration. - High index of suspicion necessary; microbiological diagnostic tests have low yield.
    Regimen1-IV rifampin ≥ 10 mg/kg daily+
    - 2-PO or IV2 2 isoniazid UD+
    - 3-PO pyrazinamide UD+
    - 4-PO ethambutol UD (adults) or - PO ethionamide (children) -

    Consider adding IV levofloxacin or moxifloxacin UD in lieu of ethambutol, especially if there is concern for isoniazid-resistant TB.

    CommentsRifampin has poor CNS penetration but is an essential drug for meningeal TB treatment. Isoniazid, - pyrazinamide, levofloxacin, and moxifloxacin have excellent CNS penetration. -

    Ethambutol has poor CNS penetration. Early use of fluoroquinolones has been associated with - improved outcomes among patients with isoniazid-resistant meningeal TB

    -
    - -
    - - - - - - - - - - - - - - - -
    Concerns RaisedIncreased risk for pyrazinamide-induced hepatotoxicity
    RegimenCan consider rifampin, isoniazid, and ethambutol without pyrazinamide when drug-susceptibility is - known and/or patient has low burden of disease
    Comments3-drug regimens may increase risk of failure or acquired drug-resistance.
    -
    - -
    - - - - - - - - - - - - - - - -
    Concerns RaisedDisseminated TB is associated with gut edema which decreases po medication bioavailability
    RegimenStandard 4-drug regimen Consider increasing po Rifampin dose (15 to 20 mg/kg daily, minimum 600 mg) - Consider IV rifampin and IV isoniazid 1 for inpatients.
    CommentsConsider obtaining TB drug levels in ensure po dosing achieves at least minimum levels
    -
    - -
    - - - - - - - - - - - - - - - -
    Concerns RaisedTube feeds may decrease TB drug bioavailability
    RegimenNo change in standard TB regimen
    CommentsHold tube feeds ≤2 hours prior and ≥1 hour after TB drug intake. Longer intervals are needed if - quinolone- containing regimens are given with divalent-cationcontainingtubefeeds
    -
    - -
    - - - - - - - - - - - - - - - -
    Concerns RaisedConsider limiting number of hepatotoxic drugs for patients with baseline ALT>3x UNL and/or advanced - liver disease. - Order of hepatotoxicity: PZA>INH>RIF
    Regimen1-RIF/INH/EMB +/- FQN 2-RIF/EMB/FQN +/- LZD or AG 3-EMB/FQN +/- LZD or AG
    CommentsConsider baseline liver enzyme elevation could be due to hepatic TB -

    3-drug regimens may increase risk of failure or acquired drug-resistance.

    -
    - -
    - - - - - - - - - - - - - - - -
    Concerns RaisedTB drug-induced hepatotoxicity - Stop TB drugs if ALT>3x UNL and patient symptomatic or ALT >5x UNL regardless of symptoms
    RegimenSequential re-introduction of TB drugs once ALT <2x UNL. - (1) Rifamycin x 5-7 days - (2) Isoniazid x 5-7 days - (3) Ethambutol x 5-7 days - (4) Need and choice of 4th agent depends on burden of disease and drug-susceptibility pattern.
    CommentsPyrazinamide is often the culprit and effective regimens can be designed without this drug. - Rifamycins are the drugs most important for sterilizing activity (i.e., cure) in TB treatment. - Consider adding a 4th drug if patient has high burden of disease.
    -
    - -

    Abbreviations: UD, usual dose; UNL, upper normal limit.

    -

    TABLE 15 NOTES

    -

    1-Some of these recommendations differ or are not addressed by 2016 ATS/CDC/IDSA drug-susceptible TB - guidelines. Drug-susceptibility testing for second-line drugs should be requested if these agents are - used.

    -

    2-Limited availability

    -

    3-Associated with peripheral neuropathy. Add B6 ≥50 mg/daily

    -

    4-Associated with irreversible peripheral and optic neuritis. Add B6 ≥ 50 mg/daily

    -

    5-Associated with otovestibular toxicity

    -

    6-These recommendations are meant for patients with known drug-susceptible TB or at low risk for drug- - resistant TB

    -
    -
    -
    - - - - - - diff --git a/app/src/main/assets/pages/table_15_summary_of_recommendations_for_treatment_of_active_tb_disease_in_persons_with_hiv.html b/app/src/main/assets/pages/table_15_summary_of_recommendations_for_treatment_of_active_tb_disease_in_persons_with_hiv.html new file mode 100644 index 0000000..53e9880 --- /dev/null +++ b/app/src/main/assets/pages/table_15_summary_of_recommendations_for_treatment_of_active_tb_disease_in_persons_with_hiv.html @@ -0,0 +1,502 @@ + + + + + + + + GA TB Reference Guide + + + + + + + +
    +
    +
    +
    + +
    +

    + 15. Summary of Recommendations for Treatment of Active TB Disease in + Persons with HIV +

    +
    +

    Last Updated June 2024

    +
    +
    +
    +
    +
      +
    • + +
      • +
    • + +
      • +
    • + +
      • +
    • + +
      • +
    • + +
      • +
    • + +
      • +
    • + +
      • +
    • + +
      • +
    • + +
      • +
    • + +
      • +
    +
    + +
    +

    + When to start ART +

    + + + + + + + + + + + + +
    What to do +
      +
    • + CD4 <50: start ART within + 2 weeks of TB therapy +
      • +
    • + CD4 ≥50: start ART by + 8–12 weeks. +
      • +
    • + TB meningitis: defer starting ART and + seek expert advice as CNS TB IRIS may increase morbidity + and mortality +
      • +
    +
    Key details/caveats + Early ART ↓ mortality.
    + CNS TB early ART ↑ severe IRIS risk. +
    +
    + +
    +

    + How to prevent IRIS in TB/HIV +

    + + + + + + + + + + + + +
    What to do +
      +
    • + Consider prednisone 40 mg/day for + 2 weeks, then + 20 mg/day for + 2 weeks for patients with + CD4 ≤100 who starting ART within 30 days + of TB treatment initiation and are responding well to TB + therapy. +
      • +
    • Consult with expert in TB/HIV.
      • +
    +
    Key details/caveats + Contraindicated for patients with rifampin-resistant TB, + Kaposi sarcoma, or active hepatitis B. +
    +
    + +
    +

    + TB Regimen: Drug-susceptible TB (DS_TB) +

    + + + + + + + + + + + + +
    What to do + Use standard 6-month HRZE → HR regimen + (intensive phase 2 months HRZE, continuation phase 4-7 months + HR) +
    Key details/caveatsRemains the global standard for HIV-associated TB
    +
    + +
    +

    + Core ART principles with rifamycins +

    + + + + + + + + + + + + +
    What to do + Rifamycins (rifampin, rifabutin, rifapentine) are the most + important TB drug in the treatment of DS-TB and every effort + should be made to include them in the treatment regimen. + However, rifamycins have many drug-drug interactions. + i +
    Key details/caveats + Rifamycins strongly induce CYP3A, UGT, P-gp, causing major ARV + interactions. +
    +
    + +
    +

    + INSTIs with rifamycin +

    + + + + + + + + + + + + +
    What to do + Dolutegravir (DTG): Increase does to 50 mg + twice daily while on rifampin. + Bictegravir (BIC) (INSTI in Biktarvy) is + contraindicated with rifampin and other rifamycins. +
    Key details/caveats +
      +
    • DTG BID validated in HIV–TB.
      • +
    • BIC levels drop severely.
      • +
    +
    +
    + +
    +

    + NNRTIs with rifampin +

    + + + + + + + + + + + + +
    What to doEfavirenz 600 mg daily is compatible.
    Key details/caveats + Efavirenz generally maintained at therapeutic levels with + rifampin. +
    +
    + +
    +

    + Boosted PIs with rifampin +

    + + + + + + + + + + + + +
    What to do + Do NOT use rifampin with ritonavir- or + cobicistat-boosted PIs. Use rifabutin instead + of rifampin if PI required (can use with ritonavir, cannot use + with cobicistat). +
    Key details/caveats +
      +
    • Monitor for uveitis and neutropenia with rifabutin.
      • +
    • + Dose adjustment for rifabutin generally required; consult + with HIV/TB expert. +
      • +
    +
    +
    + +
    +

    + NRTI backbone +

    + + + + + + + + + + + + +
    What to do + Use TDF/FTC (Truvada) or + 3TC. General recommendations are to avoid + TAF (i.e., TAF/FTC [Descovy]) use with + rifamycins. However, TAF can be used with rifampin with + caution and close monitoring of virologic response per the + DHHS/NIH HIV treatment guidelines. +
    Key details/caveats + Rifamycins lower plasma TAF concentration, but intracellular + levels are preserved. +
    +
    + +
    +

    + TB-IRIS +

    + + + + + + + + + + + + +
    What to do + Continue ART. NSAIDs for mild IRIS. + Prednisone for moderate–severe IRIS. +
    Key details/caveats + ART should NOT be stopped except in life-threatening IRIS. +
    +
    + +
    +

    + TB Meningitis +

    + + + + + + + + + + + + +
    What to do + Use adjunctive steroids. Delay start of ART. + Seek expert advice as CNS TB IRIS may increase morbidity and + mortality +
    Key details/caveatsReduces mortality and CNS IRIS.
    +
    + +
    +

    Abbreviations:

    +
      +
    • ART – Antiretroviral therapy
      • +
    • ARV – Antiretroviral
      • +
    • BIC – Bictegravir
      • +
    • CNS – Central nervous system
      • +
    • CYP3A / CYP3A4 – Major drug-metabolizing enzymes
      • +
    • DS-TB – Drug-susceptible TB
      • +
    • DTG – Dolutegravir
      • +
    • EFV – Efavirenz
      • +
    • FTC – Emtricitabine
      • +
    • HRZE – TB intensive-phase regimen:
      • +
    • H = Isoniazid
      • +
    • R = Rifampin
      • +
    • Z = Pyrazinamide
      • +
    • E = Ethambutol
      • +
    • IRIS – Immune reconstitution inflammatory syndrome
      • +
    • INSTI – Integrase strand transfer inhibitor
      • +
    • NNRTI – Non-nucleoside reverse transcriptase inhibitor
      • +
    • + NRTI – Nucleoside/nucleotide reverse transcriptase inhibitor +
      • +
    • PI – Protease inhibitor
      • +
    • P-gp – P-glycoprotein (drug efflux transporter)
      • +
    • RFB (or RIFB) – Rifabutin
      • +
    • RPT – Rifapentine
      • +
    • TAF – Tenofovir alafenamide
      • +
    • TDF – Tenofovir disoproxil fumarate
      • +
    • + TB-IRIS – TB-associated immune reconstitution inflammatory + syndrome +
      • +
    • + UGT (UDP-glucuronosyltransferase): A liver enzyme family that + metabolizes many drugs. Rifamycins induce UGT1A1, lowering levels + of drugs like dolutegravir and bictegravir. +
      • +
    + +

    Source:

    + +
    +
    +
    + + + + + + diff --git a/app/src/main/assets/pages/table_16_guidelines_for_treatment_of_extrapulmonary_tuberculosis.html b/app/src/main/assets/pages/table_16_guidelines_for_treatment_of_extrapulmonary_tuberculosis.html new file mode 100644 index 0000000..42c8b20 --- /dev/null +++ b/app/src/main/assets/pages/table_16_guidelines_for_treatment_of_extrapulmonary_tuberculosis.html @@ -0,0 +1,303 @@ + + + + + + + + GA TB Reference Guide + + + + + + + + +
    +
    +
    +
    + +
    +

    16. Guidelines for Treatment of Extrapulmonary Tuberculosis: Length of Therapy and Adjunctive Use of Corticosteroids

    +
    +

    View in chapter → Adjunctive Use of Corticosteroid Therapy

    +

    Last Updated October 2025

    +
    +
    +
    +
    +
    + + + + + + + + + + +
    +
    + + + + + + + + + + + + + + + + +
    Length of therapy6 months
    CorticosteroidsNot recommended
    Additional management considerations + Pursue microbiologic proof of diagnosis prior to starting Rx +
    + + + + + + + + + + + + + + + + +
    Length of therapy6 to 9 months
    CorticosteroidsNot recommended
    Additional management considerationsExtend to 12 months if hardware is present
    + + + + + + + + + + + + + + + + +
    Length of therapy6 to 9 months
    Corticosteroids + Not recommended for TB rx but may be indicated for cord + compression +
    Additional management considerations + Most spine infection can be cured with medical Rx. Surgery + indicated for relief of cord compression, progressive disease + despite medical therapy, instability of the spine. +
    + + + + + + + + + + + + + + + + + + + + + + + + +
    Length of therapy9 to 12 months
    CorticosteroidsStrongly recommended
    Steroid Dosing for Adults + Adults ≥ 25kg
    + 12 mg/day of
    + dexamethasone x 3 weeks
    + followed by 3-week taper +
    Steroid Dosing for Children + Children ≥ 25kg
    + 12 mg/day of
    + dexamethasone x 3 weeks
    + followed by 3-week taper

    + Children < 25kg
    + 8 mg/day of
    + dexamethasone for 3 weeks
    + followed by 3-week taper +
    Additional management considerations + Most spine infection can be cured with medical Rx. Surgery + indicated for relief of cord compression, progressive disease + despite medical therapy, instability of the spine. +
    + + + + + + + + + + + + + + + + + + + + +
    Length of therapy9-12 months
    CorticosteroidsStrongly recommended
    Steroid Dosing + A and C >= 25kg: 12 mg/day of dexamethasone x 3 weeks followed by 3-week taper

    + C < 25kg: 8 mg/day of dexamethasone for 3 weeks followed by 3-week taper +
    Additional management considerations + Negative CSF culture or PCR test does NOT exclude this diagnosis +

    Follow CSF profile for response to therapy

    +
    + + + + + + + + + + + + + + + + +
    Length of therapy6 months
    CorticosteroidsNot recommended
    Additional management considerationsEmpyema may require decortication
    + + + + + + + + + + + + + + + + +
    Length of therapy6 months
    CorticosteroidsNO LONGER routinely RECOMMENDED
    Additional management considerations + Consider steroids for patients at highest risk of later + constriction: large pericardial effusions high levels of + inflammatory cells or markers in pericardial fluid those with + early signs of constriction +
    + + + + + + + + + + + + + + + + +
    Length of therapy6 months
    CorticosteroidsNot recommended
    Additional management considerations + Obtain cultures from blood, urine and sputum in addition to + clinically apparent sites of disease. +
    + + + + + + + + + + + + + + + + +
    Length of therapy6 months
    CorticosteroidsNot recommended
    Additional management considerations
    + + + + + + + + + + + + + + + + +
    Length of therapy6 months
    CorticosteroidsNot recommended
    Additional management considerations
    + +

    + ALWAYS EVALUATE for concomitant pulmonary involvement with respiratory + samples for smear and culture (regardless of chest imaging findings). +

    +

    Based on CID 2016:63 (1 October) • Nahid et al

    +
    +
    + + + + + + diff --git a/app/src/main/assets/pages/table_16_when_to_start_hiv_therapy.html b/app/src/main/assets/pages/table_16_when_to_start_hiv_therapy.html deleted file mode 100644 index 2ffa91f..0000000 --- a/app/src/main/assets/pages/table_16_when_to_start_hiv_therapy.html +++ /dev/null @@ -1,60 +0,0 @@ - - - - - - - - GA TB Reference Guide - - - - - - - - - -
    -

    View in chapter → Antiretroviral Therapy (ART) and Treatment of Persons Living with HIV and Active TB

    -

    Last Updated October 2025

    -
    -
    - - - - - - - - - - - - - - - - - - - - - - -
    HHS Panel Recommendations on treatment of Tuberculosis Disease with HIV co-infection: Timing of Antiretroviral Therapy (ART) Initiation relative to TB treatment
    CD4 count and/or clinical status at time of TB diagnosisART Initiation
    < 50 cells/mm³within 2 weeks of starting TB therapy.
    > 50 cells/mm³within 2-8 weeks of starting TB therapy
    Pregnant, any CD4 countAs early as feasible
    -

    ** EXCEPTION: tuberculous meningitis. To avoid life-threatening CNS immune reconstitution inflammatory syndrome (IRIS), persons living with HIV and tuberculous meningitis should not be started on ART until AFTER the TB meningitis is under control and at least two weeks anti-TB treatment

    -

    - PREVENTING IRIS (Immune Reconstitution Inflammatory Syndrome): prednisone 40 mg/day for 2 weeks followed by 20 mg/day for 2 weeks is recommended for people with CD4 100 cells/mm3 who start ART within 30 days of TB treatment, are responding well to treatment, do not have known or suspected rifampin resistance, Kaposi sarcoma, or active hepatitis B. This recommendation does not apply to people with CNS TB for whom steroids are recommended from the time TB treatment is started. -

    -

    - Above based on guidelines developed by the Department of Health and Human Services (DHHS) Panel on Guidelines for Use of Antiretroviral Agents for Adults and Adolescents and Use of Antiretroviral Drugs in Pregnant Women living with HIV and Interventions to Reduce Perinatal Transmission in the United States, last reviewed and updated October 29, 2024 (https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-opportunistic-infections/mycobacterium?view=full) -

    - -
    -
    - - - - diff --git a/app/src/main/assets/pages/table_17_use_of_anti-tb_medications_in_special_situations_pregnancy_tuberculosis_meningitis_and_renal_failure.html b/app/src/main/assets/pages/table_17_use_of_anti-tb_medications_in_special_situations_pregnancy_tuberculosis_meningitis_and_renal_failure.html new file mode 100644 index 0000000..627e53f --- /dev/null +++ b/app/src/main/assets/pages/table_17_use_of_anti-tb_medications_in_special_situations_pregnancy_tuberculosis_meningitis_and_renal_failure.html @@ -0,0 +1,273 @@ + + + + + + + + GA TB Reference Guide + + + + + + + +
    +
    +
    +
    + +
    +

    17. Use of Anti-TB Medications in Special Situations: Pregnancy, Tuberculosis Meningitis, and Renal Impairment

    +
    +

    View in chapter → Treatment of Active TB in Pregnancy

    +

    Last Updated October 2025

    +
    +
    +
    +
    +
    + + + + + + + + + + + +
    + +
    + + + + + + + + + + + + + + + +
    Safety in PregnancySafe i
    Central Nervous System PenetrationGood (20-100%)
    Dosage in Renal InsufficiencyNo change
    +
    + +
    + + + + + + + + + + + + + + + +
    Safety in PregnancySafe (isolated reports of malformation)
    Central Nervous System PenetrationFair, Inflamed meninges (10-20%)
    Dosage in Renal InsufficiencyNo change
    +
    + +
    + + + + + + + + + + + + + + + +
    Safety in PregnancyCaution i
    Central Nervous System PenetrationGood (75-100%)
    Dosage in Renal InsufficiencyDecrease dose/ Increase interval
    +
    + +
    + + + + + + + + + + + + + + + +
    Safety in PregnancySafe
    Central Nervous System PenetrationInflamed meninges only (4-64%)
    Dosage in Renal InsufficiencyDecrease dose/ Increase interval
    +
    + +
    + + + + + + + + + + + + + + + +
    Safety in PregnancyAvoid
    Central Nervous System PenetrationPoor i
    Dosage in Renal InsufficiencyDecrease dose/ Increase interval i
    +
    + +
    + + + + + + + + + + + + + + + +
    Safety in PregnancyAvoid
    Central Nervous System PenetrationPoor
    Dosage in Renal InsufficiencyDecrease dose/ Increase interval i
    +
    + +
    + + + + + + + + + + + + + + + +
    Safety in PregnancyDo not use
    Central Nervous System PenetrationFair (5-10%) Inflamed meninges (50-90%)
    Dosage in Renal InsufficiencyDecrease dose/ Increase interval i
    +
    + +
    + + + + + + + + + + + + + + + +
    Safety in PregnancyAvoid
    Central Nervous System PenetrationGood (100%)
    Dosage in Renal InsufficiencyNo change
    +
    + +
    + + + + + + + + + + + + + + + +
    Safety in PregnancyAvoid
    Central Nervous System PenetrationGood (50-100%)
    Dosage in Renal InsufficiencyDecrease dose/ Increase interval
    +
    + +
    + + + + + + + + + + + + + + + +
    Safety in PregnancySafe
    Central Nervous System PenetrationInflamed meninges only (50-100%)
    Dosage in Renal InsufficiencyIncomplete data
    +
    + +
    + + + + + + + + + + + + + + + +
    Safety in PregnancyAvoid
    Central Nervous System PenetrationUnknown
    Dosage in Renal InsufficiencyProbably no change
    +
    + +
      +
    • Safe: Drug has not been demonstrated to have teratogenic effects.
      • +
    • Avoid: Limited data on safety or for aminoglycosides associated with hearing impairment and/or other toxicity.
      • +
    • Do Not Use: Associated with premature labor, congenital malformations or teratogenicity.
      • +
    +
    +
    +
    + + + + + + + diff --git a/app/src/main/assets/pages/table_17_what_to_start_choice_of_tb_therapy_and_antiretroviral_therapy_(art)_when)treating_co-infected_patients.html b/app/src/main/assets/pages/table_17_what_to_start_choice_of_tb_therapy_and_antiretroviral_therapy_(art)_when)treating_co-infected_patients.html deleted file mode 100644 index fd9e557..0000000 --- a/app/src/main/assets/pages/table_17_what_to_start_choice_of_tb_therapy_and_antiretroviral_therapy_(art)_when)treating_co-infected_patients.html +++ /dev/null @@ -1,121 +0,0 @@ - - - - - - - - GA TB Reference Guide - - - - - - - - - -
    -

    View in chapter → Antiretroviral Therapy (ART) and Treatment of Persons Living with HIV and Active TB

    -
    - - - - - - - - - - - - - - - - - - - - - -
    Principle: Despite drug interactions, a rifamycin (rifampin or rifabutin) should be included in TB - regimens for patients receiving ART, with dosage adjustment if necessary (see Table SMR11 for dosage - adjustments). -
    Option 1: Rifabutin-based - ART regimen: Integrase inhibitor and 2 NRTIs - Preferred ART choices: RAL or DTG + TDF/FTC - Alternative ART choices: DTG + ABC/3TC - Contraindicated medications: TAF, other integrase inhibitors (Bictegravir, Elvitegravir) - NOTE: Dolutegravir has higher barrier to resistance compared to raltegravir. Dolutegravir is - preferred when there is high risk poor adherence. -
    Option 2: Rifampin-based - ART regimen: Efavirenz and 2 NRTIs - Preferred ART choices: Efavirenz (NNRTI) + (TDF/FTC) Alternative ART choices: Efavirenz + ABC/3TC - Contraindicated medications: TAF, other NNRTIs: Nevaripine, Doravirine, Etravirine, or Rilpivirine - NOTE: Efavirenz is not a preferred regimen for patients initiating ART. Integrase inhibitors DTG and - RAL are preferred ART regimens for patients initiating ART but require BID dosing if used with - rifampin. Efavirenz has low barrier to resistance making this regimen less suitable when there is - high risk for poor adherence. Efavirenz is associated with neuropsychiatric side-effects. Screening - for depression and suicidality is recommended prior to and during efavirenz-based regimens. - Efavirenz + ABC/3TC is associated with higher rates of virologic failure when baseline HIV viral - load is >100.000 copies/ml. -
    Option 3: Rifabutin-based (dose adjusted) - ART regimen: boosted PI and 2 NRTIs - Preferred ART choices: ATV/r or ATV/c + TDF/FTC - DRV/r or DRV/c + TDF/FTC Alternative ART choices: ABC/3TC in place of TDF/FTC - Contraindicated medications: TAF - NOTE: PI’s have high barrier to resistance. However, given rifabutin is given at half-dose when used - with PI’s adherence to ART should be closely monitored. Poor adherence to PI’s while on rifabutin - increases risk for rifampin resistance. -
    Option 4: Rifampin-based - ART regimen: dose adjusted integrase inhibitor + 2 NRTIs - Preferred ART choices: RAL (dose adjusted) or DTG (dose adjusted)+ TDF/FTC Alternative ART choices: - DTG (dose adjusted) + ABC/3TC - Contraindicated medications: TAF, other integrase inhibitors (Bictegravir, Elvitegravir) - NOTE: Dolutegravir has higher barrier to resistance compared to raltegravir. Dolutegravir is - preferred when there is high risk poor adherence. -
    Choice for Pregnant women with active TB and HIV infection: - TB regimen: Rifabutin –based (dose adjusted) - ART regimen: boosted PI (ARV/r or DRV/r) 2 + 2 NRTIs (TDF/FTC or ABC/3TC) - NOTE: Preliminary data suggest that there is an increased risk of neural tube defects in infants - born to women who were receiving DTG at the time of conception. DTG is contraindicated for pregnant - women during first trimester and for women who are planning to become pregnant or are not using - effective contraception. DTG is the preferred integrase inhibitor after first trimester 1. -
    - -
      -
    • NRTIs: nucleoside/-tide reverse transcriptase inhibitors
      • -
    • NNRTIs: non-nucleoside reverse transcriptase inhibitors
      • -
    • PIs: protease inhibitors
      • -
    • /r: boosted with ritonavir
      • -
    • /c: boosted with cobicistat
      • -
    • TDF: Tenofovir disoproxil fumarate
      • -
    • TAF: Tenofovir alafenamide
      • -
    • FTC: Emtricitabine
      • -
    • 3TC: Lamivudine
      • -
    • ABC: Abacavir
      • -
    • ATV/r: Atazanavir/ritonavir
      • -
    • DRV/r: Daraunavir/ritonavir
      • -
    • RAL: Raltegravir
      • -
    • DTG: Dolutegravir
      • -
    - -

    Above based on guidelines developed by the Department of Health and Human Services (DHHS) Panel on Guidelines - for Use of Antiretroviral Agents for Adults and Adolescents and Use of Antiretroviral Drugs in Pregnant - Women with HIV Infection and Interventions to Reduce Perinatal Transmission in the United States, last - reviewed and updated April 15, 2019 (http://aidsinfo.nih.gov/guidelines). -

    - -

    1-Data on integrase inhibitors and pregnancy outcomes is rapidly evolving and DHHS guidelines are frequently - updated.

    - -

    2-Cobicistat is currently not recommended for pregnant women.

    - -
    -
    - - - - diff --git a/app/src/main/assets/pages/table_17_what_to_start_choice_of_tb_therapy_and_antiretroviral_therapy_(art)_when_treating_co-infected_patients.html b/app/src/main/assets/pages/table_17_what_to_start_choice_of_tb_therapy_and_antiretroviral_therapy_(art)_when_treating_co-infected_patients.html deleted file mode 100644 index 15fca1d..0000000 --- a/app/src/main/assets/pages/table_17_what_to_start_choice_of_tb_therapy_and_antiretroviral_therapy_(art)_when_treating_co-infected_patients.html +++ /dev/null @@ -1,123 +0,0 @@ - - - - - - - - GA TB Reference Guide - - - - - - - - - -
    -

    View in chapter → Antiretroviral Therapy (ART) and Treatment of Persons Living with HIV and Active TB

    -

    Last Updated June 2024

    -
    -
    - - - - - - - - - - - - - - - - - - - - - -
    Principle: Despite Drug Interactions, a Rifamycin (Rifampin or Rifabutin) Should Be Included in TB Regimens for Patients - Receiving ART, with Dosage Adjustment if Necessary (see Table SMR11 for dosage - adjustments). -
    Option 1: Rifabutin-based - ART regimen: Integrase inhibitor and 2 NRTIs - Preferred ART choices: RAL or DTG + TDF/FTC - Alternative ART choices: DTG + ABC/3TC - Contraindicated medications: TAF, other integrase inhibitors (Bictegravir, Elvitegravir) - NOTE: Dolutegravir has higher barrier to resistance compared to raltegravir. Dolutegravir is - preferred when there is high risk poor adherence. -
    Option 2: Rifampin-based - ART regimen: Efavirenz and 2 NRTIs - Preferred ART choices: Efavirenz (NNRTI) + (TDF/FTC) Alternative ART choices: Efavirenz + ABC/3TC - Contraindicated medications: TAF, other NNRTIs: Nevaripine, Doravirine, Etravirine, or Rilpivirine - NOTE: Efavirenz is not a preferred regimen for patients initiating ART. Integrase inhibitors DTG and - RAL are preferred ART regimens for patients initiating ART but require BID dosing if used with - rifampin. Efavirenz has low barrier to resistance making this regimen less suitable when there is - high risk for poor adherence. Efavirenz is associated with neuropsychiatric side-effects. Screening - for depression and suicidality is recommended prior to and during efavirenz-based regimens. - Efavirenz + ABC/3TC is associated with higher rates of virologic failure when baseline HIV viral - load is >100.000 copies/ml. -
    Option 3: Rifabutin-based (dose adjusted) - ART regimen: boosted PI and 2 NRTIs - Preferred ART choices: ATV/r or ATV/c + TDF/FTC - DRV/r or DRV/c + TDF/FTC Alternative ART choices: ABC/3TC in place of TDF/FTC - Contraindicated medications: TAF - NOTE: PI’s have high barrier to resistance. However, given rifabutin is given at half-dose when used - with PI’s adherence to ART should be closely monitored. Poor adherence to PI’s while on rifabutin - increases risk for rifampin resistance. -
    Option 4: Rifampin-based - ART regimen: dose adjusted integrase inhibitor + 2 NRTIs - Preferred ART choices: RAL (dose adjusted) or DTG (dose adjusted)+ TDF/FTC Alternative ART choices: - DTG (dose adjusted) + ABC/3TC - Contraindicated medications: TAF, other integrase inhibitors (Bictegravir, Elvitegravir) - NOTE: Dolutegravir has higher barrier to resistance compared to raltegravir. Dolutegravir is - preferred when there is high risk poor adherence. -
    Choice for Pregnant women with active TB and HIV infection: - TB regimen: Rifabutin –based (dose adjusted) - ART regimen: boosted PI (ARV/r or DRV/r) 2 + 2 NRTIs (TDF/FTC or ABC/3TC) - NOTE: Preliminary data suggest that there is an increased risk of neural tube defects in infants - born to women who were receiving DTG at the time of conception. DTG is contraindicated for pregnant - women during first trimester and for women who are planning to become pregnant or are not using - effective contraception. DTG is the preferred integrase inhibitor after first trimester 1. -
    - -
      -
    • NRTIs: nucleoside/-tide reverse transcriptase inhibitors
      • -
    • NNRTIs: non-nucleoside reverse transcriptase inhibitors
      • -
    • PIs: protease inhibitors
      • -
    • /r: boosted with ritonavir
      • -
    • /c: boosted with cobicistat
      • -
    • TDF: Tenofovir disoproxil fumarate
      • -
    • TAF: Tenofovir alafenamide
      • -
    • FTC: Emtricitabine
      • -
    • 3TC: Lamivudine
      • -
    • ABC: Abacavir
      • -
    • ATV/r: Atazanavir/ritonavir
      • -
    • DRV/r: Daraunavir/ritonavir
      • -
    • RAL: Raltegravir
      • -
    • DTG: Dolutegravir
      • -
    - -

    Above based on guidelines developed by the Department of Health and Human Services (DHHS) Panel on Guidelines - for Use of Antiretroviral Agents for Adults and Adolescents and Use of Antiretroviral Drugs in Pregnant - Women with HIV Infection and Interventions to Reduce Perinatal Transmission in the United States, last - reviewed and updated April 15, 2019 (http://aidsinfo.nih.gov/guidelines). -

    - -

    1-Data on integrase inhibitors and pregnancy outcomes is rapidly evolving and DHHS guidelines are frequently - updated.

    - -

    2-Cobicistat is currently not recommended for pregnant women.

    - -
    -
    - - - - diff --git a/app/src/main/assets/pages/table_18_dosage_adjustments_for_art_and_rifamycins_when_used_in_combination.html b/app/src/main/assets/pages/table_18_dosage_adjustments_for_art_and_rifamycins_when_used_in_combination.html deleted file mode 100644 index df41e84..0000000 --- a/app/src/main/assets/pages/table_18_dosage_adjustments_for_art_and_rifamycins_when_used_in_combination.html +++ /dev/null @@ -1,144 +0,0 @@ - - - - - - - - GA TB Reference Guide - - - - - - - - -
    -

    Table 18. Dosage Adjustments for ART and Rifamycins when used in Combination

    -

    Last Updated October 2025

    -
    -
    -
    -
    - - - -
    - -
    -

    Dolutegravir (DTG)

    - - - - - - - - - - - - - - - - -
    DrugDosing
    Rifampin (RIF)RIF: No change (600 mg)
    DTG: Increase to 50 mg BID
    Rifabutin (RBT)RBT: No change (300 mg)
    DTG: No change (50 mg)
    -
    - -
    -

    ATV/r, DRV/r

    - - - - - - - - - - - - - - - -
    DrugDosing
    Rifampin (RIF)DO NOT USE
    Rifabutin (RBT)RBT: decrease to 150 mg/d
    PIs: no change
    -
    - -
    -

    Efavirenz (EFV)
    (Note: No longer a first line ART)

    - - - - - - - - - - - - - - - -
    DrugDosing
    Rifampin (RIF)RIF no change (600 mg)
    EFV: no change (600 mg qhs)
    Rifabutin (RBT)DO NOT USE
    -
    -

    - Department of Human Health Services links for ART drug-drug interactions – these are updated frequently

    -

    Protease inhibitors: https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-arv/drug-interactions-protease-inhibitors?view=full

    - -

    NNRTIs: https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-arv/drug-interactions-nnrti?view=full

    - -

    NRTIs: https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-arv/drug-interactions-nrti?view=full

    - -

    Integrase inhibitors: https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-arv/drug-interactions-insti?view=full

    - -

    *Preliminary data suggest that there is an increased risk of neural tube defects in infants born to women - who were receiving DTG at the time of conception. DTG is contraindicated for pregnant women during first - trimester and for women who are planning to become pregnant or are not using effective contraception. - DTG is the preferred integrase inhibitor after first trimester.

    - -
      -
    • NNRTIs: non-nucleoside reverse transcriptase inhibitors
      • -
    • PIs: protease inhibitors
      • -
    • ATV/r: Atazanavir/ritonavir
      • -
    • DRV/r: Daraunavir/ritonavir
      • -
    • LPV/r: Lopinavir/ritonavir
      • -
    • RAL: Raltegravir
      • -
    • DTG: Dolutegravir
      • -
    • /c : boosted with cobicistat
      • -
    - -

    Table 18 is based on guidelines developed by the Department of Health and Human Services (DHHS) Panel on - Guidelines for Use of Antiretroviral Agents for Adults and Adolescents and Use of Antiretroviral Drugs - in Pregnant Women with HIV Infection and Interventions to Reduce Perinatal Transmission in the United - States, last reviewed and updated April 15, 2019 - (aidsinfo.nih.gov/guidelines)

    - -

    1-Data on integrase inhibitors and pregnancy outcomes is rapidly evolving and DHHS - guidelines are frequently updated.

    - -

    2-Cobicistat is currently not recommended for pregnant women.

    -
    -
    -
    - - - - - - - diff --git a/app/src/main/assets/pages/table_21_grady_hospital_tb_isolation_policy.html b/app/src/main/assets/pages/table_18_grady_hospital_tb_isolation_policy.html similarity index 68% rename from app/src/main/assets/pages/table_21_grady_hospital_tb_isolation_policy.html rename to app/src/main/assets/pages/table_18_grady_hospital_tb_isolation_policy.html index 9d2f5ca..4a1cc50 100644 --- a/app/src/main/assets/pages/table_21_grady_hospital_tb_isolation_policy.html +++ b/app/src/main/assets/pages/table_18_grady_hospital_tb_isolation_policy.html @@ -16,16 +16,19 @@
    -

    View in chapter → Surveillance for Health Care Workers

    -

    Last Updated October 2025

    +
    +
    +
    + +
    +

    18. Grady Hospital TB Isolation Policy

    +
    +

    View in chapter → Surveillance for Health Care Workers

    +

    Last Updated October 2025

    +
    -
    +
    - - - - - @@ -41,8 +44,7 @@ - + @@ -51,7 +53,6 @@
    Grady Hospital TB Isolation Policy
    Criteria for Isolation2. "Rule Out" TB
    Any patient who has sputum for AFB collected or pulmonary TB is in the differential diagnosis.     		Until 2 sputum AFB smears are negative - Until 2 sputum AFB smears are negative
    3. Person living with HIV admitted with abnormal CXR
    -
    diff --git a/app/src/main/assets/pages/table_19_guidelines_for_treatment_of_extrapulmonary_tuberculosis.html b/app/src/main/assets/pages/table_19_guidelines_for_treatment_of_extrapulmonary_tuberculosis.html deleted file mode 100644 index 25c9536..0000000 --- a/app/src/main/assets/pages/table_19_guidelines_for_treatment_of_extrapulmonary_tuberculosis.html +++ /dev/null @@ -1,255 +0,0 @@ - - - - - - - - GA TB Reference Guide - - - - - - - - -
    -

    View in chapter → Adjunctive Use of Corticosteroid Therapy

    -

    Last Updated October 2025

    -
    -
    -
    -
    - - - - - - - - - - -
    - -
    - - - - - - - - - - - - - - - -
    Length of therapy6 months
    CorticosteroidsNot recommended
    Additional management considerationsPursue microbiologic proof of diagnosis prior to starting Rx
    -
    - -
    - - - - - - - - - - - - - - - -
    Length of therapy6 to 9 months
    CorticosteroidsNot recommended
    Additional management considerationsExtend to 12 months if hardware is present
    -
    - -
    - - - - - - - - - - - - - - - -
    Length of therapy6 to 9 months
    CorticosteroidsNot recommended for TB rx but may be indicated for cord compression
    Additional management considerationsMost spine infection can be cured with medical Rx. Surgery indicated for relief of cord - compression, progressive disease despite medical therapy, instability of the spine.
    -
    - -
    - - - - - - - - - - - - - - - - - - - -
    Length of therapy9 to 12 months
    CorticosteroidsStrongly recommended
    Steroid dosingA and C ≥ 25kg: 12 mg/day of dexamethasone x 3 weeks followed by 3-week taper -

    C < 25kg: 8 mg/day of dexamethasone for 3 weeks followed by 3-week taper

    Additional management considerationsMost spine infection can be cured with medical Rx. Surgery indicated for relief of cord - compression, progressive disease despite medical therapy, instability of the spine.
    -
    - -
    - - - - - - - - - - - - - - - -
    Length of therapy9-12 months
    CorticosteroidsStrongly recommended
    Additional management considerationsNegative CSF culture or PCR test does NOT exclude this diagnosis -

    Follow CSF profile for response to therapy

    -
    - -
    - - - - - - - - - - - - - - - -
    Length of therapy6 months
    CorticosteroidsNot recommended
    Additional management considerationsEmpyema may require decortication
    -
    - -
    - - - - - - - - - - - - - - - -
    Length of therapy6 months
    CorticosteroidsNO LONGER routinely RECOMMENDED
    Additional management considerationsConsider steroids for patients at highest risk of later constriction: - large pericardial effusions high levels of inflammatory cells or markers in pericardial fluid those - with early signs of constriction
    -
    - -
    - - - - - - - - - - - - - - - -
    Length of therapy6 months
    CorticosteroidsNot recommended
    Additional management considerationsObtain cultures from blood, urine and sputum in addition to clinically apparent sites of disease.
    -
    - -
    - - - - - - - - - - - - - - - -
    Length of therapy6 months
    CorticosteroidsNot recommended
    Additional management considerations
    -
    - -
    - - - - - - - - - - - - - - - -
    Length of therapy6 months
    CorticosteroidsNot recommended
    Additional management considerations
    -
    - -

    - 2 mg/kg prednisone daily over three weeks, followed by taper Maximum dose 60 mg
    OR
    - Dexamethasone 0.3-0.6 mg/kg daily over three weeks, followed by taper Round to nearest tablet size (2, 4, 6 mg) Maximum dose 12 mg -

    -
    -
    -
    - - - - - - - diff --git a/app/src/main/assets/pages/table_1_interpretation_criteria_for_the_quantiferon_tb_gold_plus_test.html b/app/src/main/assets/pages/table_1_interpretation_criteria_for_the_quantiferon_tb_gold_plus_test.html index 099e50e..4d594e8 100644 --- a/app/src/main/assets/pages/table_1_interpretation_criteria_for_the_quantiferon_tb_gold_plus_test.html +++ b/app/src/main/assets/pages/table_1_interpretation_criteria_for_the_quantiferon_tb_gold_plus_test.html @@ -15,10 +15,19 @@
    -

    View in chapter → Interferon-y Release Assays (IGRAs)

    -

    Last Updated October 2025

    +
    +
    +
    + +
    +

    1. Interpretation Criteria for the QuantiFERON-TB Gold Plus Test (QFT-Plus)

    +
    +

    View in chapter → Interferon-y Release Assays (IGRAs)

    +

    Last Updated October 2025

    +
    -
    +
    +

    Possible Test Results

      • @@ -29,83 +38,83 @@ - - - - - - - - - - - - - - - - - - - - - - + + + + + + + + + + + + + + + + + + + + + +
      Nil (IU/ml) < 8.0
      TB1 minus Nil (IU/ml)> 0.35 and > 25% of NilAny
      TB2 minus Nil (IU/ml)Any> 0.35 and > 25% of Nil
      Mitogen minus NilAny
      Report/InterpretationM. tuberculosis infection likely
      Nil (IU/ml) < 8.0
      TB1 minus Nil (IU/ml)> 0.35 and > 25% of NilAny
      TB2 minus Nil (IU/ml)Any> 0.35 and > 25% of Nil
      Mitogen minus NilAny
      Report/InterpretationM. tuberculosis infection likely
      - +
      - - - - - - - - - - - - - - - - - - - - - + + + + + + + + + + + + + + + + + + + + +
      Nil (IU/ml) < 8.0
      TB1 minus Nil (IU/ml)< 0.35 or > 0.35 and < 25 % of Nil
      TB2 minus Nil (IU/ml)< 0.35 or > 0.35 and < 25% of Nil
      Mitogen minus Nil > 0.50
      Report/InterpretationM. tuberculosis infection not likely
      Nil (IU/ml) < 8.0
      TB1 minus Nil (IU/ml)< 0.35 or > 0.35 and < 25 % of Nil
      TB2 minus Nil (IU/ml)< 0.35 or > 0.35 and < 25% of Nil
      Mitogen minus Nil > 0.50
      Report/InterpretationM. tuberculosis infection not likely
      - - - - - - - - - - - - - - - - - - - - - - - - + + + + + + + + + + + + + + + + + + + + + + + +
      Nil (IU/ml) < 8.0> 8.0
      TB1 minus Nil (IU/ml)< 0.35 or > 0.35 and < 25% of NilAny
      TB2 minus Nil (IU/ml)< 0.35 or > 0.35 and < 25% of NilAny
      Mitogen minus Nil < 0.50Any
      Report/InterpretationLikelihood of M. tuberculosis infection cannot be determined
      Nil (IU/ml) < 8.0> 8.0
      TB1 minus Nil (IU/ml)< 0.35 or > 0.35 and < 25% of NilAny
      TB2 minus Nil (IU/ml)< 0.35 or > 0.35 and < 25% of NilAny
      Mitogen minus Nil < 0.50Any
      Report/InterpretationLikelihood of M. tuberculosis infection cannot be determined
    diff --git a/app/src/main/assets/pages/table_20_use_of_anti-tb_medications_in_special_situations_pregnancy_tuberculosis_meningitis_and_renal_failure.html b/app/src/main/assets/pages/table_20_use_of_anti-tb_medications_in_special_situations_pregnancy_tuberculosis_meningitis_and_renal_failure.html deleted file mode 100644 index 4c7946f..0000000 --- a/app/src/main/assets/pages/table_20_use_of_anti-tb_medications_in_special_situations_pregnancy_tuberculosis_meningitis_and_renal_failure.html +++ /dev/null @@ -1,283 +0,0 @@ - - - - - - - - GA TB Reference Guide - - - - - - - -
    -

    View in chapter → Treatment of Active TB in Pregnancy

    -

    Last Updated October 2025

    -
    -
    -
    -
    - - - - - - - - - - - -
    - -
    - - - - - - - - - - - - - - - -
    Safety in PregnancySafe (4)
    Central Nervous System PenetrationGood (20-100%)
    Dosage in Renal InsufficiencyNo change
    -
    - -
    - - - - - - - - - - - - - - - -
    Safety in PregnancySafe (isolated reports of malformation)
    Central Nervous System PenetrationFair, Inflamed meninges (10-20%)
    Dosage in Renal InsufficiencyNo change
    -
    - -
    - - - - - - - - - - - - - - - -
    Safety in PregnancyCaution (1)
    Central Nervous System PenetrationGood (75-100%)
    Dosage in Renal InsufficiencyDecrease dose/ Increase interval
    -
    - -
    - - - - - - - - - - - - - - - -
    Safety in PregnancySafe
    Central Nervous System PenetrationInflamed meninges only (4-64%)
    Dosage in Renal InsufficiencyDecrease dose/ Increase interval
    -
    - -
    - - - - - - - - - - - - - - - -
    Safety in PregnancyAvoid
    Central Nervous System PenetrationPoor (5)
    Dosage in Renal InsufficiencyDecrease dose/ Increase interval (6)
    -
    - -
    - - - - - - - - - - - - - - - -
    Safety in PregnancyAvoid
    Central Nervous System PenetrationPoor
    Dosage in Renal InsufficiencyDecrease dose/ Increase interval (6)
    -
    - -
    - - - - - - - - - - - - - - - -
    Safety in PregnancyDo not use
    Central Nervous System PenetrationFair (5-10%) Inflamed meninges (50-90%)
    Dosage in Renal InsufficiencyDecrease dose/ Increase interval (7)
    -
    - -
    - - - - - - - - - - - - - - - -
    Safety in PregnancyAvoid
    Central Nervous System PenetrationGood (100%)
    Dosage in Renal InsufficiencyNo change
    -
    - -
    - - - - - - - - - - - - - - - -
    Safety in PregnancyAvoid
    Central Nervous System PenetrationGood (50-100%)
    Dosage in Renal InsufficiencyDecrease dose/ Increase interval
    -
    - -
    - - - - - - - - - - - - - - - -
    Safety in PregnancySafe
    Central Nervous System PenetrationInflamed meninges only (50-100%)
    Dosage in Renal InsufficiencyIncomplete data
    -
    - -
    - - - - - - - - - - - - - - - -
    Safety in PregnancyAvoid
    Central Nervous System PenetrationUnknown
    Dosage in Renal InsufficiencyProbably no change
    -
    - -

    Safe: Drug has not been demonstrated to have teratogenic effects.

    -

    Avoid: Limited data on safety or for aminoglycosides associated with hearing impairment and/or - other toxicity.

    -

    Do Not Use: Associated with premature labor, congenital malformations or teratogenicity.

    -

    NOTES: Table 20 Special Situations

    - -

    (1) As with all medications given during pregnancy, anti-TB drugs should be used with caution. The risk of TB to - the fetus far outweighs the risk of medications. Pregnant patients with active TB should be treated. Data are - limited on the safety of some anti-TB drugs during pregnancy. Table 20 presents a consensus of published data - and recommendations. Although detailed teratogenic data is not available, PZA can probably be used safely for - pregnant patients. Concentrations of anti-TB drugs in breast milk are low; treatment with these medications is - not a contraindication to breastfeeding. (Conversely, medication present in breast milk is not sufficient to - prevent or treat TB in the newborn.) Consult a medical expert when treating a pregnant patient who has TB. For - treatment of LTBI, most authorities recommend beginning INH several months after delivery, unless the woman is - at high risk for progression to active TB (e.g., recent TST or IGRA conversion, HIV-infected).

    -

    (2) Steroid treatment appears to improve outcome in TB meningitis, particularly in patients with altered mental - status.

    -

    (3) If possible, monitor serum drug levels of patients with renal insufficiency. See page 71 for dosage.

    -

    (4) Supplement with pyridoxine (Vitamin B6) during pregnancy.

    -

    (5) Has been used intrathecally; efficacy not documented.

    -

    (6) Avoid aminoglycosides and capreomycin in patients with reversible renal damage, if possible.

    -

    (7) Fluoroquinolones may accumulate in renal failure and are poorly removed by dialysis. Dose adjustment - indicated.

    -
    -
    -
    - - - - - - - diff --git a/app/src/main/assets/pages/table_2_interpretation_criteria_for_the_t_spot_tb_test.html b/app/src/main/assets/pages/table_2_interpretation_criteria_for_the_t_spot_tb_test.html index fe3e05d..09fbc78 100644 --- a/app/src/main/assets/pages/table_2_interpretation_criteria_for_the_t_spot_tb_test.html +++ b/app/src/main/assets/pages/table_2_interpretation_criteria_for_the_t_spot_tb_test.html @@ -1,131 +1,175 @@ - + - - - - + + + + GA TB Reference Guide - - - - - + + + + + - - -
    -

    View in chapter → Interferon-y Release Assays (IGRAs)

    -

    Last Updated October 2025

    -
    -
    + +
    +
    +
    +
    + +
    +

    + 2. Interpretation Criteria for the T-SPOT.TB Test +

    +
    +

    + + View in chapter → + + + Interferon-y Release Assays (IGRAs) + + +

    +

    Last Updated October 2025

    +
    +
    +
      -
      • -
      • -
      • -
      • +
      • +
      • +
      • +
    - - - - - - - - - - - - + + + + + + + + + + + + +
    Nil*≤ 10 spots
    TB Response†≥ 8 spots
    Mitogen§Any
    Nil + i≤ 10 spots
    TB Response + i≥ 8 spots
    Mitogen + i + Any
    - - - - - - - - - - - - + + + + + + + + + + + +
    Nil*< 10 spots
    TB Response†5, 6, or 7 spots
    Mitogen§Any
    Nil + i + < 10 spots
    TB Response + i + 5, 6, or 7 spots
    Mitogen + i + Any
    - - - - - - - - - - - - + + + + + + + + + + + +
    Nil*≤ 10 spots
    TB Response†> 20 spots
    Mitogen§> 20 spots
    Nil + i + ≤ 10 spots
    TB Response + i + > 20 spots
    Mitogen + i + > 20 spots
    - - - - - - - - - - - - - - - + + + + + + + + + + + + + + +
    Nil*≤ 10 spots≤ 10 spots
    TB Response†Any< 5 spots
    Mitogen§Any< 20 spots
    Nil + i + ≤ 10 spots≤ 10 spots
    TB Response + i + Any< 5 spots
    Mitogen + i + Any< 20 spots
    -

    - Source: Based on Oxford Immunotec T-Spot.TB package insert.
    - Available at: - http://www.oxfordimmunotec.com/international/wp-content/uploads/sites/3/Final-File-PI-TB-US-V6.pdf - -

    - -

    * The number of spots resulting from incubation of PBMCs in culture media without antigens.
    - † The greater number of spots resulting from stimulation of peripheral - blood mononuclear cells (PBMCs) with two separate cocktails of peptides - representing early secretory antigenic target-6 (ESAT-6) or culture filtrate - protein-10 (CFP-10) minus Nil.
    - § The number of spots resulting from stimulation of PBMCs with mitogen - without adjustment for the number of spots resulting from incubation of - PBMCs without antigens.
    - ¶ Interpretation indicating that Mycobacterium tuberculosis infection is - likely.
    - ** Interpretation indicating an uncertain likelihood of M. tuberculosis infection. In the case of Invalid - results, these should be reported as “Invalid” - and it is recommended to collect another sample and retest the individual.
    - †† Interpretation indicating that M. tuberculosis infection is not likely.

    - -
    - +

    + Source: Based on Oxford Immunotec T-Spot.TB package insert.
    + Available at: + + http://www.oxfordimmunotec.com/international/wp-content/uploads/sites/3/Final-File-PI-TB-US-V6.pdf + +

    +

    + 1. Interpretation indicating that Mycobacterium tuberculosis infection + is likely.
    + 2. Interpretation indicating an uncertain likelihood of M. tuberculosis + infection. In the case of Invalid results, these should be reported as + “Invalid” and it is recommended to collect another sample and retest the + individual.
    + 3. Interpretation indicating that M. tuberculosis infection is not + likely. +

    +
    + - - - + + + diff --git a/app/src/main/assets/pages/table_3_high_prevalence_and_high_risk_groups.html b/app/src/main/assets/pages/table_3_high_prevalence_and_high_risk_groups.html index f7a4c0c..4eb9959 100644 --- a/app/src/main/assets/pages/table_3_high_prevalence_and_high_risk_groups.html +++ b/app/src/main/assets/pages/table_3_high_prevalence_and_high_risk_groups.html @@ -15,10 +15,18 @@
    -

    View in chapter → Targeted Testing and Diagnostic Tests

    -

    Last Updated October 2025

    +
    +
    +
    + +
    +

    3. High Prevalence and High Risk Groups

    +
    +

    View in chapter → Targeted Testing and Diagnostic Tests

    +

    Last Updated October 2025

    +
    -
    +
    @@ -27,17 +35,17 @@ - - + - - - - +
    Persons born in countries with high rates of TBPersons living with HIV Persons who are close contacts of persons with infectious active TB + Persons living with HIV Persons who are close contacts of persons with infectious active TB
    Groups with poor access to healthcareChildren less than 6 years of ageChildren less than 5 years of age
    Persons who live or spend time in certain facilities (e.g., nursing homes, correctional institutions, - homeless shelters, drug treatment centers) + homeless shelters, drug treatment centers) Persons with recent infection with M. tuberculosis (e.g., have had a diagnostic test result for LTBI convert to positive in the past 1-2 years) Persons who have chest radiographs suggestive of old TB @@ -45,13 +53,8 @@
    Persons who inject drugsPersons with certain medical conditions*
    *Diabetes mellitus, silicosis, prolonged therapy with corticosteroids, immunosuppressive - therapy particularly TNF-α blockers, leukemia, Hodgkin’s disease, head and neck cancers, - severe kidney disease, certain intestinal conditions, malnutrition - Persons with certain medical conditions i
    @@ -61,4 +64,5 @@ + diff --git a/app/src/main/assets/pages/table_4_recommendations_for_regimens_to_treat_latent_tuberculosis_infection.html b/app/src/main/assets/pages/table_4_recommendations_for_regimens_to_treat_latent_tuberculosis_infection.html index c490880..6b9f8fc 100644 --- a/app/src/main/assets/pages/table_4_recommendations_for_regimens_to_treat_latent_tuberculosis_infection.html +++ b/app/src/main/assets/pages/table_4_recommendations_for_regimens_to_treat_latent_tuberculosis_infection.html @@ -15,77 +15,92 @@
    -

    View in chapter → Treatment Regimens for LTBI

    -

    Last Updated October 2025

    +
    +
    +
    + +
    +

    4. Recommendations for Regimens to Treat Latent Tuberculosis Infection

    +
    +

    View in chapter → Treatment Regimens for LTBI

    +

    Last Updated October 2025

    +
    -
    +
      -
      • -
      • +
      • +
    - - - - - - - - - - - - - - - - - - + + + + + + + + + + + + + + + + + + + + + + + +
    Regimes3 months isoniazid plus rifapentine given once weekly4 months rifampin given daily3 months isoniazid plus rifampin given daily
    Recommendation (Strong or Conditional)StrongStrongConditional
    Evidence (High, Moderate, Low, or Very Low)ModerateModerate (HIV negative) † Very low (HIV negative) †
    Regimes3 months isoniazid plus rifapentine4 months rifampin3 months isoniazid plus rifampin
    FrequencyOnce weeklyDailyDaily
    Recommendation (Strong or Conditional)StrongStrongConditional
    Evidence (High, Moderate, Low, or Very Low)ModerateModerate (HIV negative) i Very low (HIV negative) / Low (HIV positive) i
    - - - - - - - - - - - - - - - - - - + + + + + + + + + + + + + + + + + + + + + + + +
    Regimes6 months isoniazid given daily9 months isoniazid given daily3 months isoniazid plus rifampin given daily
    Recommendation (Strong or Conditional)Strong §ConditionalConditional
    Evidence (High, Moderate, Low, or Very Low)Moderate (HIV negative)Moderate (if living with HIV)Moderate
    Regimes6 months isoniazid6 months isoniazid9 months isoniazid
    FrequencyDailyDailyDaily
    Recommendation (Strong or Conditional)Strong iConditionalConditional
    Evidence (High, Moderate, Low, or Very Low)Moderate (HIV negative)Moderate (if living with HIV)Moderate
    - -

    Abbreviation: HIV = human immunodeficiency virus
    - * Preferred: excellent tolerability and efficacy, shorter treatment duration, - higher completion rates than longer regimens, and therefore higher - effectiveness. Alternative: excellent efficacy but concerns regarding longer - treatment duration, lower completion rates, and therefore lower effectiveness. -
    † No evidence reported in HIV-positive persons.
    - § Strong recommendation for those persons unable to take a preferred - regimen (e.g., due to drug intolerability or drug-drug interactions). -

    + +

    Abbreviation: HIV = human immunodeficiency virus

    +

    1. Preferred: excellent tolerability and efficacy, shorter treatment duration, higher completion rates than longer regimens, and therefore higher effectiveness.
    + 2. Alternative: excellent efficacy but concerns regarding longer treatment duration, lower completion rates, and therefore lower effectiveness.

    + diff --git a/app/src/main/assets/pages/table_5_dosages_for_recommended_lbti_treatment_regimens.html b/app/src/main/assets/pages/table_5_dosages_for_recommended_lbti_treatment_regimens.html index 8d9e426..afa311d 100644 --- a/app/src/main/assets/pages/table_5_dosages_for_recommended_lbti_treatment_regimens.html +++ b/app/src/main/assets/pages/table_5_dosages_for_recommended_lbti_treatment_regimens.html @@ -15,149 +15,160 @@
    -

    View in chapter → Treatment Regimens for LTBI

    -

    Last Updated October 2025

    +
    +
    +
    + +
    +

    5. Dosages for Recommended LTBI Treatment Regimens

    +
    +

    View in chapter → Treatment Regimens for LTBI

    +

    Last Updated October 2025

    +
    - - + + diff --git a/app/src/main/assets/pages/table_6_ltbi_treatment_drug_adverse_reactions.html b/app/src/main/assets/pages/table_6_ltbi_treatment_drug_adverse_reactions.html index 869e26f..a5b5fbc 100644 --- a/app/src/main/assets/pages/table_6_ltbi_treatment_drug_adverse_reactions.html +++ b/app/src/main/assets/pages/table_6_ltbi_treatment_drug_adverse_reactions.html @@ -1,107 +1,224 @@ - + - - - + + + GA TB Reference Guide - - - - + + + + + -
    -

    View in chapter → Treatment Regimens for LTBI

    -

    Last Updated October 2025

    -
    -
    +
    +
    +
    + +
    +

    6. LTBI Treatment Drug Adverse Reactions

    +
    +

    + + View in chapter → + + + Treatment Regimens for LTBI + + + +

    +

    Last Updated October 2025

    +
    +
    +
      -
      • -
      • -
      • +
    • + +
      • +
    • + +
      • +
    • + +
    - +
    - - - - - - - - - - - - + + + + + + + + + + + +
    Adverse Reactions - Gastrointestinal (GI) upset, hepatic enzyme elevations, hepatitis, peripheral neuropathy, mild effects on central nervous system (CNS), drug interactions -
    - Monitoring - - Order baseline hepatic chemistry blood tests (at least AST or ALT) for patients with specific conditions: Living with HIV, liver disorders, postpartum period (<3 months after delivery), regular alcohol use, injection drug use, or use of medications with known possible interactions. [Some clinicians prefer to obtain baseline tests on all adults]. Repeat measurements if: * baseline results are abnormal * client is at high-risk for adverse reactions * client has symptoms of adverse reactions -
    - Comments - - Hepatitis risk increases with age and alcohol consumption. Pyridoxine can prevent isoniazid-induced peripheral neuropathy. -
    Adverse Reactions + Gastrointestinal (GI) upset, hepatic enzyme elevations, + hepatitis, peripheral neuropathy, mild effects on central + nervous system (CNS), drug interactions +
    Monitoring + Order baseline hepatic chemistry blood tests (at least AST or + ALT) for patients with specific conditions: Living with HIV, + liver disorders, postpartum period (<3 months after delivery), + regular alcohol use, injection drug use, or use of medications + with known possible interactions. [Some clinicians prefer to + obtain baseline tests on all adults]. Repeat measurements if: + baseline results are abnormal + client is at high-risk for adverse reactions + client has symptoms of adverse reactions +
    Comments + Hepatitis risk increases with age and alcohol consumption. + Pyridoxine can prevent isoniazid-induced peripheral neuropathy. +
    - - - - - - - - - - - - + + + + + + + + + + + +
    Adverse Reactions - Orange discoloration of body fluids (secretions, tears, urine) , GI upset, drug interactions, hepatitis, thrombocytopenia, rash, fever, influenza-like symptoms, hypersensitivity reaction* Many drug-drug interactions -
    - Monitoring - - Complete blood count (CBC), platelets and liver function tests. - Repeat measurements if: * baseline results are abnormal * client has symptoms of adverse reactions  Prior to starting RIF or RPT: need to carefully review all medications being taken by the patient with LTBI and ensure there is no contraindication to the use of that medication and RIF, RBT or RPT. -
    - Comments - - Hepatitis risk increases with age and alcohol consumption. Rifampin monotherapy is associated with lower risk of hepatotoxicity compared to INH monotherapy for patients being treated for LTBI. Need to carefully review for possible drug-drug interactions prior to starting RIF, RBT or RPT and ensure there are no contraindications to these agents prior to using them for the treatment of LTBI.
    Adverse Reactions + Orange discoloration of body fluids (secretions, tears, urine) , + GI upset, drug interactions, hepatitis, thrombocytopenia, rash, + fever, influenza-like symptoms, hypersensitivity reaction + i + Many drug-drug interactions +
    Monitoring + Complete blood count (CBC), platelets and liver function tests. + Repeat measurements if: + baseline results are abnormal + client has symptoms of adverse reactions  Prior to starting RIF + or RPT: need to carefully review all medications being taken by + the patient with LTBI and ensure there is no contraindication to + the use of that medication and RIF, RBT or RPT. +
    Comments + Hepatitis risk increases with age and alcohol consumption. + Rifampin monotherapy is associated with lower risk of + hepatotoxicity compared to INH monotherapy for patients being + treated for LTBI. Need to carefully review for possible + drug-drug interactions prior to starting RIF, RBT or RPT and + ensure there are no contraindications to these agents prior to + using them for the treatment of LTBI. +
    - - - - - - - - - - - - + + + + + + + + + + + +
    Adverse ReactionsSee adverse effects associated with isoniazid alone and a rifamycin alone (see above)
    MonitoringComplete blood count (CBC), platelets and liver function tests. - Repeat measurements if: * baseline results are abnormal * client has symptoms of adverse reactions  Prior to starting RIF or RPT: need to carefully review all medications being taken by the patient with LTBI and ensure there is no contraindication to the use of that medication and RIF or RPT.
    CommentsApproximately 4% of all patients using 3HP experience flu-like or other systemic drug reactions, with fever, headache, dizziness, nausea, muscle and bone pain, rash, itching, red eyes, or other symptoms. Approximately 5% of persons discontinue 3HP because of adverse events, including systemic drug reactions; these reactions typically occur after the first 3–4 doses, and begin approximately 4 hours after ingestion of medication.
    Adverse Reactions + See adverse effects associated with isoniazid alone and a + rifamycin alone (see above) +
    Monitoring + Complete blood count (CBC), platelets and liver function tests. + Repeat measurements if: + baseline results are abnormal + client has symptoms of adverse reactions  Prior to starting RIF + or RPT: need to carefully review all medications being taken by + the patient with LTBI and ensure there is no contraindication to + the use of that medication and RIF or RPT. +
    Comments + Approximately 4% of all patients using 3HP experience flu-like + or other systemic drug reactions, with fever, headache, + dizziness, nausea, muscle and bone pain, rash, itching, red + eyes, or other symptoms. Approximately 5% of persons discontinue + 3HP because of adverse events, including systemic drug + reactions; these reactions typically occur after the first 3–4 + doses, and begin approximately 4 hours after ingestion of + medication. +
    -

    - * Hypersensitivity reaction to rifamycins (rifampin, rifabutin, rifapentine): reactions may include a flu-like syndrome (e.g. fever, chills, headaches, dizziness, musculoskeletal pain), thrombocytopenia, shortness of breath or other signs and symptoms including wheezing, acute bronchospasm, urticaria, petechiae, purpura, pruritus, conjunctivitis, angioedema, hypotension or shock. If moderate to severe reaction (e.g. thrombocytopenia, hypotension), hospitalization or life-threatening event: Discontinue treatment. If mild reaction (e.g. rash, dizziness, fever): Continue to monitor patient closely with a low threshold for discontinuing treatment. A flu-like syndrome appears to be the most common side effect profile leading to discontinuation of the 3HP regimen. Rifabutin can rarely cause uveitis. -

    +

    Additional Notes:

    +
      +
    • Hypersensitivity reaction to rifamycins (rifampin, rifabutin, or rifapentine): reactions may include a flu-like syndrome (e.g. fever, chills, headaches, dizziness, musculoskeletal pain), thrombocytopenia, shortness of breath or other signs and symptoms including wheezing, acute bronchospasm, urticaria, petechiae, purpura, pruritus, conjunctivitis, angioedema, hypotension or shock.
      • +
    • If moderate to severe reaction (e.g. thrombocytopenia, hypotension), hospitalization or life-threatening event: Discontinue treatment.
      • +
    • If mild reaction (e.g. rash, dizziness, fever): Continue to monitor patient closely with a low threshold for discontinuing treatment.
      • +
    • A flu-like syndrome appears to be the most common side effect profile leading to discontinuation of the 3HP regimen.
      • +
    • Rifabutin can rarely cause uveitis.
      • +
    diff --git a/app/src/main/assets/pages/table_7_recommended_regimens_for_treatment_of_adults_and_children_with_drug_susceptible_tb_pulmonary_tb.html b/app/src/main/assets/pages/table_7_recommended_regimens_for_treatment_of_adults_and_children_with_drug_susceptible_tb_pulmonary_tb.html index a85677d..a663d2e 100644 --- a/app/src/main/assets/pages/table_7_recommended_regimens_for_treatment_of_adults_and_children_with_drug_susceptible_tb_pulmonary_tb.html +++ b/app/src/main/assets/pages/table_7_recommended_regimens_for_treatment_of_adults_and_children_with_drug_susceptible_tb_pulmonary_tb.html @@ -16,112 +16,104 @@
    -

    View in chapter → Special Clinical Situations

    -

    Last Updated October 2025

    +
    +
    +
    + +
    +

    7. Recommended Regimens for Treatment of Adults and Children with Drug-Susceptible TB (Pulmonary TB)

    +
    +

    View in chapter → Special Clinical Situations

    +

    Last Updated October 2025

    +
    @@ -130,4 +122,5 @@

    Continuation Phase

    + diff --git a/app/src/main/assets/pages/table_8_first-line_tb_drugs_dosing_for_adults_(ages_16_and_over)_directly_observed_therapy_(dot)_is_mandatory.html b/app/src/main/assets/pages/table_8_first-line_tb_drugs_dosing_for_adults_(ages_16_and_over)_directly_observed_therapy_(dot)_is_mandatory.html index cc9b027..fcc4106 100644 --- a/app/src/main/assets/pages/table_8_first-line_tb_drugs_dosing_for_adults_(ages_16_and_over)_directly_observed_therapy_(dot)_is_mandatory.html +++ b/app/src/main/assets/pages/table_8_first-line_tb_drugs_dosing_for_adults_(ages_16_and_over)_directly_observed_therapy_(dot)_is_mandatory.html @@ -15,9 +15,16 @@
    - -

    View in chapter → Special Clinical Situations

    -

    Last Updated October 2025

    +
    +
    +
    + +
    +

    8. First-line TB Drugs: Dosing for Adults (ages 16 and over) Directly Observed Therapy (DOT) is mandatory

    +
    +

    View in chapter → Special Clinical Situations

    +

    Last Updated October 2025

    +
    @@ -26,8 +33,8 @@
    • -
    • -
    • +
    • +
    • @@ -40,7 +47,7 @@ Thrice-Weekly - Adult Dose based on body weight in kilograms (kg)* + Adult Dose based on body weight in kilograms (kg) i 300 mg 900 mg @@ -69,7 +76,7 @@ Thrice-Weekly - Adult Dose based on body weight in kilograms (kg)* + Adult Dose based on body weight in kilograms (kg) i 600 mg 600 mg @@ -101,7 +108,7 @@ Thrice-Weekly - Adult Dose based on body weight in kilograms (kg)* + Adult Dose based on body weight in kilograms (kg) i 300 mg Not recommended @@ -133,7 +140,7 @@ Thrice-Weekly - Adult Dose based on body weight in kilograms (kg)* + Adult Dose based on body weight in kilograms (kg) i 40-55 kg: 1000 mg 40-55 kg: 1500 mg @@ -149,14 +156,12 @@ Adverse Reactions
      -
    • Orange discoloration of body fluids and secretions
      • -
    • Drug interactions
    • GI upset
      • +
    • Joint aches
    • Hepatitis
      • -
    • Bleeding problems
      • -
    • Influenze-like symptoms
    • Rash
      • -
    • Uveitis (rifabutin only)
      • +
    • Hyperuricemia
      • +
    • Gout (rare)
    @@ -173,7 +178,7 @@ Thrice-Weekly - Adult Dose based on body weight in kilograms (kg)* + Adult Dose based on body weight in kilograms (kg) i 40-55 kg: 800 mg 40-55 kg: 1200 mg @@ -196,17 +201,14 @@
    + +
      +
    1. Calculate pyrazinamide and ethambutol doses using actual body weight. Pyrazinamide and ethambutol dosage adjustment is needed in patients with estimated creatinine clearance less than 50 ml/min or those with end-stage renal disease on dialysis.
      2. +
    + +

    Additional Note: Refer to current drug reference or drug package insert for a complete list of adverse drug reactions and drug interactions.

    Source: https://academic.oup.com/cid/article/63/7/e147/2196792?login=trueas

    - -

    *Formula used to convert pounds to kilograms: Divide pounds by 2.2 to get kilograms.

    -

    Example: Patient weighs 154 pounds ÷ 2.2 = 70 kilograms.

    -

    ** Calculate pyrazinamide and ethambutol doses using actual body weight. Pyrazinamide and ethambutol dosage - adjustment is needed in patients with estimated creatinine clearance less than 50 ml/min or those with - end-stage renal disease on dialysis.

    -

    NOTE: Refer to current drug reference or drug package insert for a complete list of adverse drug reactions - and drug interactions.

    -
    @@ -214,4 +216,5 @@ + diff --git a/app/src/main/assets/pages/table_9_pediatric_dosage_isoniazid_in_children_(birth_to_15_years).html b/app/src/main/assets/pages/table_9_pediatric_dosage_isoniazid_in_children_(birth_to_15_years).html index 2fb16f6..2c5a73c 100644 --- a/app/src/main/assets/pages/table_9_pediatric_dosage_isoniazid_in_children_(birth_to_15_years).html +++ b/app/src/main/assets/pages/table_9_pediatric_dosage_isoniazid_in_children_(birth_to_15_years).html @@ -16,132 +16,330 @@
    -

    View in chapter → Special Clinical Situations

    -

    Last Updated October 2025

    +
    +
    +
    + +
    +

    9. Pediatric Dosage in Children (Birth to 15 Years)

    +
    +

    View in chapter → Special Clinical Situations

    +

    Last Updated October 2025

    +
    - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
    Child's Weight (lbs)Child's Weight (kg)Daily Dose (mg) 10-15
    6 - 103 - 4.550
    11 - 145.0 - 6.050
    14.5 - 186.5 – 8.0100
    18.5 - 21.58.5 – 9.5100
    22 – 2410.0 – 11150
    25 - 2911.5 - 13150
    29.5 - 3213.5 - 14.5200
    33 - 3515 - 16200
    36 - 4016.5 - 18250
    40.5 - 4318.5 - 19.5250
    44 - 4820 - 21.5300
    48.5 - 5122 - 23300
    52 - 54.523.5 - 24.5300
    55 - 57.525 - 26300
    58 - 6226.5 - 28300
    62.5 - 6528.5 - 29.5300
    66 +30 +300
    - -

    NOTE: Isoniazid tablets come in 50 mg, 100mg, 300 mg sizes and can be crushed for oral administration. - Isoniazid tablets are also scored.

    -

    Isoniazid Syrup (50mg/5ml) should not be refrigerated. It contains sorbitol and will cause diarrhea. It - should be used only when crushed tablets cannot accommodate the situation. (keep at room temperature).

    + +
    +
      +
      • +
      • +
      • +
      • +
    +
    +
    + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
    Child's Weight (lbs)Child's Weight (kg)Daily Dose (mg) 10-15 mg/kg PO
    6 - 103 - 4.550
    11 - 145.0 - 6.050
    14.5 - 186.5 – 8.0100
    18.5 - 21.58.5 – 9.5100
    22 – 2410.0 – 11150
    25 - 2911.5 - 13150
    29.5 - 3213.5 - 14.5200
    33 - 3515 - 16200
    36 - 4016.5 - 18250
    40.5 - 4318.5 - 19.5250
    44 - 4820 - 21.5300
    48.5 - 5122 - 23300
    52 - 54.523.5 - 24.5300
    55 - 57.525 - 26300
    58 - 6226.5 - 28300
    62.5 - 6528.5 - 29.5300
    66 +30 +300
    + +

    NOTE: Isoniazid tablets come in 50 mg, 100mg, 300 mg sizes and can be crushed for oral administration. + Isoniazid tablets are also scored.

    +

    Isoniazid Syrup (50mg/5ml) should not be refrigerated. It contains sorbitol and will cause diarrhea. It + should be used only when crushed tablets cannot accommodate the situation. (keep at room temperature).

    +
    + +
    +
    + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
    Child's Weight (lbs)Child's Weight (kg)Daily Dose (mg) 10-20 mg/kg
    15 - 32 7 - 14.5150 mg
    33 - 48.515 - 22300 mg
    49 - 6522.5 - 29.5450 mg
    66 +30 +600 mg
    +
    +
    + +
    +
    + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
    Child’s Weight (lbs)Child’s Weight (kg)Daily Dose (mg) 15 – 25 mg/kg
    11 – 155 – 7100 mg
    16 – 318 – 14200 mg
    32 – 4415 – 20300 mg
    45 – 5521 – 25400 mg
    56 – 6726 – 30.5500 mg
    68 – 7631 – 34.5600 mg
    77 – 8735 – 39.5700 mg
    88 – 12140 – 55800 mg
    122 – 16556 – 751200 mg
    166 +76 +1600 mg
    +

    Additional Notes:
    + The maximum recommendation for ethambutol is 1g daily. +

    +
    +
    + +
    +
    + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
    Child's Weight (lbs)Child's Weight (kg)Daily Dose (mg) 30-40 mg/kg
    13 - 236 - 10.5250 mg
    24 - 2611 - 12250 mg
    27 - 3112.5 - 14500 mg
    32 - 4114.5 - 18.5500 mg
    42 - 4719.0 - 21.5750 mg
    48 - 5422.0 - 24.5750 mg
    55 – 6325 – 28.51000 mg
    64 – 6729 – 30.51000 mg
    68 – 8031 – 36.51250 mg
    81 – 9337 – 42.51500 mg
    94 – 10643 – 48.51750 mg
    107 +49 +2000 mg
    +
    +
    + diff --git a/app/src/main/java/org/apphatchery/gatbreferenceguide/db/dao/ChapterDao.kt b/app/src/main/java/org/apphatchery/gatbreferenceguide/db/dao/ChapterDao.kt index a374eb1..38eab42 100644 --- a/app/src/main/java/org/apphatchery/gatbreferenceguide/db/dao/ChapterDao.kt +++ b/app/src/main/java/org/apphatchery/gatbreferenceguide/db/dao/ChapterDao.kt @@ -14,7 +14,11 @@ interface ChapterDao { fun insert(data: List) - @Query("SELECT * FROM ChapterEntity WHERE chapterTitle LIKE '%' || :keyword || '%' ORDER BY chapterId") + @Query( + "SELECT * FROM ChapterEntity " + + "WHERE chapterTitle LIKE '%' || :keyword || '%' " + + "ORDER BY CASE WHEN chapterId = 18 THEN 0 ELSE 1 END, chapterId" + ) fun getChapterEntity(keyword: String = ""): Flow> diff --git a/app/src/main/java/org/apphatchery/gatbreferenceguide/ui/adapters/FAChapterAdapter.kt b/app/src/main/java/org/apphatchery/gatbreferenceguide/ui/adapters/FAChapterAdapter.kt index 3c569ae..3300099 100644 --- a/app/src/main/java/org/apphatchery/gatbreferenceguide/ui/adapters/FAChapterAdapter.kt +++ b/app/src/main/java/org/apphatchery/gatbreferenceguide/ui/adapters/FAChapterAdapter.kt @@ -12,6 +12,10 @@ import org.apphatchery.gatbreferenceguide.utils.ROMAN_NUMERALS class FAChapterAdapter : ListAdapter(DiffUtilCallBack()) { + private companion object { + const val UNNUMBERED_CHAPTER_ID = 18 + } + class DiffUtilCallBack : DiffUtil.ItemCallback() { override fun areItemsTheSame(oldItem: ChapterEntity, newItem: ChapterEntity) = @@ -33,10 +37,20 @@ class FAChapterAdapter : fun onBinding(chapterEntity: ChapterEntity, index: Int) = bind.apply { - (ROMAN_NUMERALS[index].uppercase() + ". " + chapterEntity.chapterTitle).also { - textView.text = it + if (chapterEntity.chapterId == UNNUMBERED_CHAPTER_ID) { + textView.text = chapterEntity.chapterTitle + return@apply } + // Number chapters using their position among numbered chapters only, + // so inserting an unnumbered item doesn't shift the Roman numerals. + val numberedIndex = currentList + .subList(0, index + 1) + .count { it.chapterId != UNNUMBERED_CHAPTER_ID } - 1 + + val roman = ROMAN_NUMERALS.getOrNull(numberedIndex)?.uppercase() + textView.text = if (roman != null) "$roman. ${chapterEntity.chapterTitle}" else chapterEntity.chapterTitle + } diff --git a/app/src/main/java/org/apphatchery/gatbreferenceguide/ui/fragments/BodyFragment.kt b/app/src/main/java/org/apphatchery/gatbreferenceguide/ui/fragments/BodyFragment.kt index 473e8f3..912170a 100644 --- a/app/src/main/java/org/apphatchery/gatbreferenceguide/ui/fragments/BodyFragment.kt +++ b/app/src/main/java/org/apphatchery/gatbreferenceguide/ui/fragments/BodyFragment.kt @@ -96,6 +96,7 @@ import androidx.activity.OnBackPressedCallback import android.widget.LinearLayout import android.widget.RelativeLayout import com.google.android.material.bottomsheet.BottomSheetDialog +import org.apphatchery.gatbreferenceguide.utils.toShortTableTitle @AndroidEntryPoint class BodyFragment : BaseFragment(R.layout.fragment_body) { @@ -136,6 +137,8 @@ class BodyFragment : BaseFragment(R.layout.fragment_body) { private lateinit var id: String private lateinit var title: String + private var subChapterByUrl: Map = emptyMap() + private lateinit var webViewFont: WebView private lateinit var sharedPreferences: SharedPreferences private var fontValue: Array = arrayOf("Small", "Normal", "Large", "Larger") @@ -184,6 +187,9 @@ class BodyFragment : BaseFragment(R.layout.fragment_body) { val scaleFactor = fontSize / 125.0 val iconPx = 16.0 * scaleFactor val iconPxStr = String.format("%.2f", iconPx) + // Make table icons slightly larger at Normal (125%) + val tableIconPx = 24.0 * scaleFactor + val tableIconPxStr = String.format("%.2f", tableIconPx) // Compute scaled metrics for the decorative line used by `.uk-paragraph` val remBasePx = 16.0 // 1rem baseline @@ -218,6 +224,18 @@ class BodyFragment : BaseFragment(R.layout.fragment_body) { })(); """.trimIndent() + // Tag table icons (ic_table.svg) similarly + val tagTableIcons = """ + (function(){ + try { + var nodes = document.querySelectorAll('img[src$="ic_chart.svg"], img[src*="/ic_chart.svg"], img[src*="ic_chart.svg"]'); + nodes.forEach(function(n){ + if(n.classList && !n.classList.contains('ic_chart_icon')) n.classList.add('ic_chart_icon'); + }); + } catch(e) {} + })(); + """.trimIndent() + // 3) Inject an explicit override rule with !important placed after external CSS val injectOverride = """ (function(){ @@ -234,6 +252,22 @@ class BodyFragment : BaseFragment(R.layout.fragment_body) { })(); """.trimIndent() + // Inject explicit override for table icons after external CSS + val injectTableOverride = """ + (function(){ + try { + var style = document.getElementById('table-icon-override'); + if(!style){ + style = document.createElement('style'); + style.id = 'table-icon-override'; + document.head.appendChild(style); + } + var size='${tableIconPxStr}px'; + style.textContent = '.ic_chart_icon{width:'+size+' !important;height:'+size+' !important;display:inline-block !important;vertical-align:middle !important;object-fit:contain !important;}'; + } catch(e) {} + })(); + """.trimIndent() + // 4) also apply inline size and attributes so pages missing style.css still resize correctly val sizeIcons = """ (function(){ @@ -264,6 +298,35 @@ class BodyFragment : BaseFragment(R.layout.fragment_body) { })(); """.trimIndent() + // Apply inline size fallback for table icons (resists layout squeeze) + val sizeTableIcons = """ + (function(){ + try { + var cssSize='${tableIconPxStr}px'; + var attrSize='${tableIconPxStr}'; + var nodes = document.querySelectorAll('img[src$=\"ic_chart.svg\"], img[src*=\"/ic_chart.svg\"], img[src*=\"ic_chart.svg\"]'); + nodes.forEach(function(n){ + var p = n.parentElement; + if (p) { + p.style.width = cssSize; + p.style.height = cssSize; + } + n.style.display = 'inline-block'; + n.style.width = cssSize; + n.style.height = cssSize; + n.style.maxWidth = cssSize; + n.style.maxHeight = cssSize; + n.style.objectFit = 'contain'; + n.style.verticalAlign = 'middle'; + if (n.setAttribute) { + n.setAttribute('width', attrSize); + n.setAttribute('height', attrSize); + } + }); + } catch(e) {} + })(); + """.trimIndent() + // 5) Scale the decorative line for paragraphs `.uk-paragraph::before` to match text zoom val paragraphOverride = """ (function(){ @@ -296,6 +359,11 @@ class BodyFragment : BaseFragment(R.layout.fragment_body) { webViewFont.post { webViewFont.evaluateJavascript(setVar, null) webViewFont.evaluateJavascript(tagIcons, null) + webViewFont.evaluateJavascript(tagTableIcons, null) + webViewFont.evaluateJavascript(injectOverride, null) + webViewFont.evaluateJavascript(injectTableOverride, null) + webViewFont.evaluateJavascript(sizeIcons, null) + webViewFont.evaluateJavascript(sizeTableIcons, null) webViewFont.evaluateJavascript(injectOverride, null) webViewFont.evaluateJavascript(sizeIcons, null) webViewFont.evaluateJavascript(paragraphOverride, null) @@ -426,7 +494,7 @@ class BodyFragment : BaseFragment(R.layout.fragment_body) { // For regular content, use the subchapter title HtmlCompat.fromHtml(subChapterEntity.subChapterTitle, FROM_HTML_MODE_LEGACY).toString() } - setActionBarTitle(contentTitle) + setActionBarTitle(contentTitle.toShortTableTitle()) // Setup search functionality only for subchapter content (not charts) if (chartAndSubChapter == null) { @@ -446,6 +514,11 @@ class BodyFragment : BaseFragment(R.layout.fragment_body) { // } // }, viewLifecycleOwner, Lifecycle.State.RESUMED) + // Cache subchapters for quick toolbar-title updates when navigating via in-page links + viewModel.getSubChapter.observeOnce(viewLifecycleOwner) { data -> + subChapterByUrl = data.associateBy { it.url } + } + faNoteColorAdapter = FANoteColorAdapter(requireContext()).also { it.submitList(NOTE_COLOR) } @@ -662,6 +735,8 @@ class BodyFragment : BaseFragment(R.layout.fragment_body) { val checkBox = findViewById(R.id.select) findViewById(R.id.closeDialog).setOnClickListener { dismiss() } noteColorRecyclerView.apply { + // Reset selection to default (first color) for new notes + faNoteColorAdapter.selectedColor = NOTE_COLOR[0].color adapter = faNoteColorAdapter layoutManager = LinearLayoutManager(requireContext(), LinearLayoutManager.HORIZONTAL, false) @@ -868,9 +943,9 @@ class BodyFragment : BaseFragment(R.layout.fragment_body) { visitButton.setOnClickListener { dismiss() - hideKeyboard() // Dismiss keyboard before navigating to home - // Navigate to bookmarks/home page - findNavController().popBackStack(R.id.mainFragment, false) + hideKeyboard() // Dismiss keyboard before navigating + // Navigate to bookmarks screen + findNavController().navigate(R.id.savedFragment) } dismissButton.setOnClickListener { @@ -956,12 +1031,70 @@ class BodyFragment : BaseFragment(R.layout.fragment_body) { super.onPageFinished(view, url) urlGlobal = url + // Keep the toolbar in sync when a user navigates to a different subchapter + // using an in-page "View in chapter" link. + updateToolbarTitleForLoadedUrl(url) + + // If the loaded url contains an anchor (fragment), attempt to scroll + // to the element with that id. This helps when WebView doesn't + // automatically jump to the fragment target on some devices. + try { + url?.let { + val hashIndex = it.indexOf('#') + if (hashIndex != -1 && hashIndex < it.length - 1) { + val anchor = it.substring(hashIndex + 1) + val density = resources.displayMetrics.density + // Offset so the table title isn't clipped under the toolbar/header. + val topOffsetPx = (50f * density).toInt() + val safeAnchor = anchor.replace("'", "\\'") + val jsScroll = "javascript:(function(){" + + "var anchor='$safeAnchor';" + + "var offset=$topOffsetPx;" + + "function findTarget(){" + + " return document.getElementById(anchor) || " + + " document.querySelector('[name=\\\"' + anchor + '\\\"]') || " + + " document.querySelector('a[name=\\\"' + anchor + '\\\"]');" + + "}" + + "function scrollToTarget(tries){" + + " var el=findTarget();" + + " if(!el){ if(tries>0){ setTimeout(function(){scrollToTarget(tries-1);}, 100);} return; }" + + " var rect=el.getBoundingClientRect();" + + " var y=rect.top + window.pageYOffset - offset;" + + " if(y<0) y=0;" + + " window.scrollTo({top:y, behavior:'smooth'});" + + "}" + + "scrollToTarget(10);" + + "})()" + view?.evaluateJavascript(jsScroll, null) + } + } + } catch (e: Exception) { + // ignore + } + // Re-apply font and icon scaling on every page load updateFont() val searchInput = bodyUrl.searchQuery if (searchInput.isNotEmpty() && !isOnlyWhitespace(searchInput)) { + // Prefill the inline search input so the user sees the query and counter + try { + searchEditText.setText(searchInput) + showSearchView() + } catch (e: Exception) { + // ignore if views not yet initialized + } + // Ensure the WebView search listener is installed so the counter updates + try { + bind.bodyWebView.setOnSearchResultListener { totalMatchesParam, currentMatchParam -> + this@BodyFragment.totalMatches = totalMatchesParam + this@BodyFragment.currentMatch = currentMatchParam + updateSearchUI() + } + } catch (e: Exception) { + // ignore if WebView not ready + } // expand any collapsed sections containing the search term expandSectionsWithSearchResults(searchInput) @@ -976,6 +1109,9 @@ class BodyFragment : BaseFragment(R.layout.fragment_body) { val allowedString = normalizeString(searchInput) val searchBody = allowedString.split(" ") + val highlightColorInt = ContextCompat.getColor(requireContext(), R.color.reddish) + val highlightHex = String.format("#%06X", 0xFFFFFF and highlightColorInt) + for (eachWord in searchBody) { val jsCode = "javascript:(function() { " + "var count = 0;" + @@ -984,12 +1120,12 @@ class BodyFragment : BaseFragment(R.layout.fragment_body) { " var html = obj.innerHTML;" + " var regex = new RegExp('(?]*>)' + str + '(?![^<]*?>)', 'gi');" + " var allOccurrences = html.match(regex);" + - " count = allOccurrences.length;" + + " count = allOccurrences ? allOccurrences.length : 0;" + " for (var i = 0; i < count; i++) {" + " var occurrence = allOccurrences[i];" + " var span = document.createElement('span');" + - " span.style.backgroundColor = 'yellow';" + - " span.style.color = 'black';" + + " span.style.backgroundColor = '" + highlightHex + "';" + + " span.style.color = '#000000';" + " span.style.fontWeight = 'normal';" + " span.innerHTML = occurrence;" + " html = html.replace(new RegExp('(?]*>)' + occurrence + '(?![^<]*?>)', 'gi'), span.outerHTML);" + @@ -1045,12 +1181,20 @@ class BodyFragment : BaseFragment(R.layout.fragment_body) { } link.contains("#") -> { + // Ensure we mark this as a subchapter link so state-dependent + // logic elsewhere uses the correct type (e.g., bookmarks). bookmarkType = BookmarkType.SUBCHAPTER - BodyFragmentDirections.actionBodyFragmentSelf( - bodyUrl.copy( - chapterEntity = ChapterEntity(chapterTitle = chapterEntity.chapterTitle) - ), null - ).also { findNavController().navigate(it) } + // Let the WebView load fragment/anchor links directly so the browser + // will jump to the anchor. Also ensure we attempt a JS scroll after + // the page finishes loading in case the fragment navigation didn't + // move the viewport. + try { + view?.loadUrl(link) + } catch (e: Exception) { + // Fallback: navigate via nav controller to the target page (without anchor) + val stripLink = link.substring(link.lastIndexOf("/") + 1, link.length) + gotoNavController(stripLink.replace(EXTENSION, "")) + } true } @@ -1066,6 +1210,20 @@ class BodyFragment : BaseFragment(R.layout.fragment_body) { } } + private fun updateToolbarTitleForLoadedUrl(url: String?) { + if (url.isNullOrBlank()) return + + // Example: file:///.../pages/some_subchapter.html#table1 + val fileName = url.substringAfterLast('/').substringBefore('#') + if (!fileName.endsWith(EXTENSION)) return + + val slug = fileName.removeSuffix(EXTENSION) + val subChapter = subChapterByUrl[slug] ?: return + + val titleText = HtmlCompat.fromHtml(subChapter.subChapterTitle, FROM_HTML_MODE_LEGACY).toString() + setActionBarTitle(titleText.toShortTableTitle()) + } + fun isOnlyWhitespace(str: String): Boolean { val trimmedStr = str.trim() return trimmedStr.isEmpty() diff --git a/app/src/main/java/org/apphatchery/gatbreferenceguide/ui/fragments/FontSizeFragment.kt b/app/src/main/java/org/apphatchery/gatbreferenceguide/ui/fragments/FontSizeFragment.kt new file mode 100644 index 0000000..a89d692 --- /dev/null +++ b/app/src/main/java/org/apphatchery/gatbreferenceguide/ui/fragments/FontSizeFragment.kt @@ -0,0 +1,81 @@ +package org.apphatchery.gatbreferenceguide.ui.fragments + +import android.content.SharedPreferences +import android.os.Bundle +import android.view.View +import android.widget.TextView +import androidx.fragment.app.Fragment +import androidx.navigation.fragment.findNavController +import androidx.preference.PreferenceManager +import com.google.android.material.slider.Slider +import dagger.hilt.android.AndroidEntryPoint +import org.apphatchery.gatbreferenceguide.R +import org.apphatchery.gatbreferenceguide.databinding.FragmentFontSizeBinding + +@AndroidEntryPoint +class FontSizeFragment : Fragment(R.layout.fragment_font_size) { + + private lateinit var bind: FragmentFontSizeBinding + private lateinit var sharedPreferences: SharedPreferences + + override fun onViewCreated(view: View, savedInstanceState: Bundle?) { + super.onViewCreated(view, savedInstanceState) + bind = FragmentFontSizeBinding.bind(view) + sharedPreferences = PreferenceManager.getDefaultSharedPreferences(requireContext()) + + setupFontSlider() + updateFontPreview() + } + + private fun updateFontPreview() { + val fontIndex = + sharedPreferences.getString(getString(R.string.font_key), "1")?.toInt() ?: 1 + val fontSizePercent = when (fontIndex) { + 0 -> 100 // Small + 1 -> 125 // Normal + 2 -> 150 // Large + 3 -> 175 // Larger + else -> 125 + } + + // Apply font scaling to the quote text + val baseQuoteSize = 16f + val baseAuthorSize = 14f + val scaleFactor = fontSizePercent / 125.0f + + bind.quoteText.textSize = baseQuoteSize * scaleFactor + bind.authorText.textSize = baseAuthorSize * scaleFactor + } + + private fun setupFontSlider() { + val fontSettingsSlider: Slider = bind.fontSizeSlider + val currentFontSizeIndex = + sharedPreferences.getString(getString(R.string.font_key), "1")?.toInt() ?: 1 + + // Set initial slider position + when (currentFontSizeIndex) { + 0 -> fontSettingsSlider.value = 100F + 1 -> fontSettingsSlider.value = 125F + 2 -> fontSettingsSlider.value = 150F + else -> fontSettingsSlider.value = 175F + } + + // Listen for slider changes + fontSettingsSlider.addOnChangeListener { _, value, _ -> + val selectedIndex = when (value) { + 100F -> 0 + 125F -> 1 + 150F -> 2 + 175F -> 3 + else -> 1 + } + + sharedPreferences.edit() + .putString(getString(R.string.font_key), selectedIndex.toString()) + .apply() + + // Update preview immediately + updateFontPreview() + } + } +} diff --git a/app/src/main/java/org/apphatchery/gatbreferenceguide/ui/fragments/GlobalSearchFragment.kt b/app/src/main/java/org/apphatchery/gatbreferenceguide/ui/fragments/GlobalSearchFragment.kt index 401b57c..9e52024 100644 --- a/app/src/main/java/org/apphatchery/gatbreferenceguide/ui/fragments/GlobalSearchFragment.kt +++ b/app/src/main/java/org/apphatchery/gatbreferenceguide/ui/fragments/GlobalSearchFragment.kt @@ -478,8 +478,10 @@ class GlobalSearchFragment : BaseFragment(R.layout.fragment_global_search) { val pattern = word.replace(Regex("[\\s.,]+"), "") if (pattern.isNotEmpty()) { val regex = Regex("(?i)($pattern)") + val highlightColor = ContextCompat.getColor(requireContext(), R.color.primary_300) + val hex = String.format("#%06X", 0xFFFFFF and highlightColor) result = result.replace(regex) { - "${it.value}" + "${it.value}" } } } diff --git a/app/src/main/java/org/apphatchery/gatbreferenceguide/ui/fragments/MainFragment.kt b/app/src/main/java/org/apphatchery/gatbreferenceguide/ui/fragments/MainFragment.kt index ac5f699..4d1ba75 100644 --- a/app/src/main/java/org/apphatchery/gatbreferenceguide/ui/fragments/MainFragment.kt +++ b/app/src/main/java/org/apphatchery/gatbreferenceguide/ui/fragments/MainFragment.kt @@ -137,8 +137,8 @@ class MainFragment : BaseFragment(R.layout.fragment_main) { add(data[13].copy(chartEntity = data[13].chartEntity.copy(chartTitle = "IV Therapy Drugs"))) add(data[14].copy(chartEntity = data[14].chartEntity.copy(chartTitle = "Alternative Regimens"))) add(data[4].copy(chartEntity = data[4].chartEntity.copy(chartTitle = "Dosages for LTBI Regimens"))) - add(data[18].copy(chartEntity = data[18].chartEntity.copy(chartTitle = "Treatment of Extra- pulmonary TB"))) - add(data[19].copy(chartEntity = data[19].chartEntity.copy(chartTitle = "TB drugs in Special Situations"))) + add(data[15].copy(chartEntity = data[15].chartEntity.copy(chartTitle = "Treatment of Extra- pulmonary TB"))) + add(data[17].copy(chartEntity = data[17].chartEntity.copy(chartTitle = "TB drugs in Special Situations"))) adapter.submitList(this) } } diff --git a/app/src/main/java/org/apphatchery/gatbreferenceguide/ui/fragments/PrivacyPolicy.kt b/app/src/main/java/org/apphatchery/gatbreferenceguide/ui/fragments/PrivacyPolicy.kt index 2a1a7ec..4c54d68 100644 --- a/app/src/main/java/org/apphatchery/gatbreferenceguide/ui/fragments/PrivacyPolicy.kt +++ b/app/src/main/java/org/apphatchery/gatbreferenceguide/ui/fragments/PrivacyPolicy.kt @@ -15,7 +15,7 @@ class PrivacyPolicy : BaseFragment(R.layout.fragment_web_view) { override fun onViewCreated(view: View, savedInstanceState: Bundle?) { bind = FragmentWebViewBinding.bind(view) val baseURL = "file://" + requireContext().cacheDir.toString() + "/" - bind.bodyWebView.loadUrl(baseURL + PAGES_DIR + "privacy_policy" + EXTENSION) + bind.bodyWebView.loadUrl(baseURL + PAGES_DIR + "georgia_tb_privacy_policy" + EXTENSION) } } \ No newline at end of file diff --git a/app/src/main/java/org/apphatchery/gatbreferenceguide/ui/fragments/SettingsFragment.kt b/app/src/main/java/org/apphatchery/gatbreferenceguide/ui/fragments/SettingsFragment.kt index 0411f6c..79bf99d 100644 --- a/app/src/main/java/org/apphatchery/gatbreferenceguide/ui/fragments/SettingsFragment.kt +++ b/app/src/main/java/org/apphatchery/gatbreferenceguide/ui/fragments/SettingsFragment.kt @@ -9,9 +9,9 @@ import android.widget.TextView import androidx.appcompat.app.AppCompatDelegate import androidx.fragment.app.viewModels import androidx.navigation.fragment.findNavController -import androidx.preference.ListPreference import androidx.preference.Preference import androidx.preference.PreferenceFragmentCompat +import androidx.preference.SwitchPreference import dagger.hilt.android.AndroidEntryPoint import org.apphatchery.gatbreferenceguide.R import org.apphatchery.gatbreferenceguide.ui.viewmodels.FASettingsViewModel @@ -26,7 +26,7 @@ class SettingsFragment : PreferenceFragmentCompat() { private val viewModel by viewModels() companion object { - const val CONTACT_EMAIL = "morgan.greenleaf@emory.edu" + const val CONTACT_EMAIL = "support@apphatchery.org" } private fun composeEmail() = Intent(Intent.ACTION_VIEW).apply { @@ -34,53 +34,64 @@ class SettingsFragment : PreferenceFragmentCompat() { startActivity(this) } + override fun onViewCreated(view: View, savedInstanceState: Bundle?) { + super.onViewCreated(view, savedInstanceState) + setDivider(null) + setDividerHeight(0) + } + override fun onCreatePreferences(savedInstanceState: Bundle?, rootKey: String?) { setPreferencesFromResource(R.xml.root_preferences, rootKey) - val themeValue: Array = - requireActivity().resources.getStringArray(R.array.theme_values) - val fontValue: Array = - requireActivity().resources.getStringArray(R.array.font_entries) - findPreference(getString(R.string.theme_key))?.let { - it.summary = - if (it.value.toString() == themeValue[0]) "System default" else it.value.toString() - .replaceFirstChar { if (it.isLowerCase()) it.titlecase(Locale.getDefault()) else it.toString() } + // Font Size preference -> opens font settings page + findPreference(getString(R.string.font_key))?.setOnPreferenceClickListener { + findNavController().navigate( + SettingsFragmentDirections + .actionSettingsFragmentToFontSizeFragment() + ) + true + } + // Dark Mode switch + findPreference("dark_mode_key")?.let { + // Set initial state based on current theme + val currentNightMode = AppCompatDelegate.getDefaultNightMode() + it.isChecked = currentNightMode == AppCompatDelegate.MODE_NIGHT_YES + it.onPreferenceChangeListener = Preference.OnPreferenceChangeListener { _, newValue -> - when { - newValue.toString() == themeValue[1] -> { - AppCompatDelegate.setDefaultNightMode(AppCompatDelegate.MODE_NIGHT_NO) - } - newValue.toString() == themeValue[2] -> { - AppCompatDelegate.setDefaultNightMode(AppCompatDelegate.MODE_NIGHT_YES) - } - else -> { - AppCompatDelegate.setDefaultNightMode(AppCompatDelegate.MODE_NIGHT_FOLLOW_SYSTEM) - } + val nightMode = if (newValue as Boolean) { + AppCompatDelegate.MODE_NIGHT_YES + } else { + AppCompatDelegate.MODE_NIGHT_NO } - requireActivity().recreate() + + // Apply theme change with animation + view?.postDelayed({ + AppCompatDelegate.setDefaultNightMode(nightMode) + }, 200) + true } } - findPreference(getString(R.string.font_key))?.let { - it.summary = fontValue[it.value.toString().toInt()] - it.onPreferenceChangeListener = Preference.OnPreferenceChangeListener { _, newValue -> - it.summary = fontValue[newValue.toString().toInt()] + // Contact Us + findPreference(getString(R.string.contact_us_key))?.let { + it.setOnPreferenceClickListener { + composeEmail() true } } - - findPreference(getString(R.string.contact_us_key))?.let { + // Give Feedback + findPreference("give_feedback_key")?.let { it.setOnPreferenceClickListener { + // Navigate to feedback or open email composeEmail() true } } - - /*Privacy Policy OnPreferenceClickListener*/ + // Legal (Privacy Policy) findPreference(getString(R.string.privacy_policy_key)).also { it?.setOnPreferenceClickListener { findNavController().navigate( @@ -91,8 +102,7 @@ class SettingsFragment : PreferenceFragmentCompat() { } } - - /*About Us OnPreferenceClickListener*/ + // About findPreference(getString(R.string.about_us_key)).also { it?.setOnPreferenceClickListener { findNavController().navigate( @@ -103,7 +113,7 @@ class SettingsFragment : PreferenceFragmentCompat() { } } - /*Reset App OnPreferenceClickListener*/ + // Clear App Content (Reset) findPreference(getString(R.string.reset_key)).also { it?.setOnPreferenceClickListener { with(Dialog(requireContext()).dialog()) { @@ -111,19 +121,17 @@ class SettingsFragment : PreferenceFragmentCompat() { val message = findViewById(R.id.message) val yesButton = findViewById(R.id.yesButton) val noButton = findViewById(R.id.noButton) - "Are you sure you want to reset all data ?".also { message.text = it } + "Are you sure you want to clear all app content?".also { message.text = it } noButton.setOnClickListener { dismiss() } yesButton.setOnClickListener { dismiss() viewModel.resetInfo(requireContext()) - requireContext().toast("App data has been reset.") + requireContext().toast("App content has been cleared.") } safeDialogShow() } true } } - - } } \ No newline at end of file diff --git a/app/src/main/java/org/apphatchery/gatbreferenceguide/utils/ExtensionMethods.kt b/app/src/main/java/org/apphatchery/gatbreferenceguide/utils/ExtensionMethods.kt index 699a30c..218fb7b 100644 --- a/app/src/main/java/org/apphatchery/gatbreferenceguide/utils/ExtensionMethods.kt +++ b/app/src/main/java/org/apphatchery/gatbreferenceguide/utils/ExtensionMethods.kt @@ -89,4 +89,16 @@ fun EditText.toggleSoftKeyboard(context: Context, showSoftKeyboard: Boolean = tr fun getActionBar(context: Context) = (context as AppCompatActivity).supportActionBar +// Extract compact table title from a full title like +// "Table 3: High Prevalence and High-Risk Groups" -> "Table 3" +private val TABLE_SHORT_TITLE_REGEX = + Regex("""\b(?:Table)\s*\d+[A-Za-z]?""", RegexOption.IGNORE_CASE) + +fun String.toShortTableTitle(): String { + val match = TABLE_SHORT_TITLE_REGEX.find(this) ?: return this + val token = match.value + // Ensure leading word has proper case + return if (token.first().isLowerCase()) token.replaceFirstChar { it.titlecase() } else token +} + diff --git a/app/src/main/java/org/apphatchery/gatbreferenceguide/utils/Utils.kt b/app/src/main/java/org/apphatchery/gatbreferenceguide/utils/Utils.kt index e086a55..85ebda8 100644 --- a/app/src/main/java/org/apphatchery/gatbreferenceguide/utils/Utils.kt +++ b/app/src/main/java/org/apphatchery/gatbreferenceguide/utils/Utils.kt @@ -8,12 +8,13 @@ val CSS_JS_FILES = arrayOf("assets/uikit.css", "assets/uikit.js", "assets/uikit- val NOTE_COLOR = arrayListOf( NoteColor("#000000"), NoteColor("#FF2D55"), - NoteColor("#AF52DE"), + NoteColor("#ff9500"), NoteColor("#FFCC00"), NoteColor("#34C759"), NoteColor("#5AC8FA"), NoteColor("#007AFF"), NoteColor("#5856D6"), + NoteColor("#af52de") ) const val ANALYTICS_PAGE_EVENT = "page" diff --git a/app/src/main/res/layout/dialog_note.xml b/app/src/main/res/layout/dialog_note.xml index 6ef1c39..5306314 100644 --- a/app/src/main/res/layout/dialog_note.xml +++ b/app/src/main/res/layout/dialog_note.xml @@ -85,7 +85,6 @@ android:layout_width="match_parent" android:layout_height="match_parent" android:layout_centerInParent="true" - android:layout_marginStart="20dp" android:padding="4dp" android:clipChildren="false" android:clipToPadding="false" /> diff --git a/app/src/main/res/layout/fragment_font_size.xml b/app/src/main/res/layout/fragment_font_size.xml new file mode 100644 index 0000000..8d83460 --- /dev/null +++ b/app/src/main/res/layout/fragment_font_size.xml @@ -0,0 +1,94 @@ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + diff --git a/app/src/main/res/layout/fragment_global_search.xml b/app/src/main/res/layout/fragment_global_search.xml index 7479fca..6113aba 100644 --- a/app/src/main/res/layout/fragment_global_search.xml +++ b/app/src/main/res/layout/fragment_global_search.xml @@ -215,34 +215,52 @@ diff --git a/app/src/main/res/layout/fragment_main_first_6_chapter_item.xml b/app/src/main/res/layout/fragment_main_first_6_chapter_item.xml index 6bd5515..ffbf47f 100644 --- a/app/src/main/res/layout/fragment_main_first_6_chapter_item.xml +++ b/app/src/main/res/layout/fragment_main_first_6_chapter_item.xml @@ -14,16 +14,18 @@ app:cardBackgroundColor="?attr/chapterBackgroundColorWhite"> + diff --git a/app/src/main/res/layout/preference_item_custom.xml b/app/src/main/res/layout/preference_item_custom.xml new file mode 100644 index 0000000..743f107 --- /dev/null +++ b/app/src/main/res/layout/preference_item_custom.xml @@ -0,0 +1,41 @@ + + + + + + + + + + diff --git a/app/src/main/res/layout/preference_item_no_chevron.xml b/app/src/main/res/layout/preference_item_no_chevron.xml new file mode 100644 index 0000000..b7f0c82 --- /dev/null +++ b/app/src/main/res/layout/preference_item_no_chevron.xml @@ -0,0 +1,31 @@ + + + + + + + + diff --git a/app/src/main/res/layout/preference_switch_custom.xml b/app/src/main/res/layout/preference_switch_custom.xml new file mode 100644 index 0000000..7c71076 --- /dev/null +++ b/app/src/main/res/layout/preference_switch_custom.xml @@ -0,0 +1,40 @@ + + + + + + + + + + diff --git a/app/src/main/res/layout/preference_switch_no_chevron.xml b/app/src/main/res/layout/preference_switch_no_chevron.xml new file mode 100644 index 0000000..37b8d8f --- /dev/null +++ b/app/src/main/res/layout/preference_switch_no_chevron.xml @@ -0,0 +1,30 @@ + + + + + + + + diff --git a/app/src/main/res/navigation/nav_graph.xml b/app/src/main/res/navigation/nav_graph.xml index 16a8b35..19f79e0 100644 --- a/app/src/main/res/navigation/nav_graph.xml +++ b/app/src/main/res/navigation/nav_graph.xml @@ -181,6 +181,13 @@ android:id="@+id/settingsFragment" android:name="org.apphatchery.gatbreferenceguide.ui.fragments.SettingsFragment" android:label="Settings"> + + - - - + app:layout="@layout/preference_category_custom" + app:title="In-Chapter Accessibility"> - - + + + app:key="give_feedback_key" + android:layout="@layout/preference_item_custom" + app:title="Give Feedback" /> + + app:key="@string/about_us_key" + android:layout="@layout/preference_item_custom" + app:title="About" /> + + android:layout="@layout/preference_item_no_chevron" + app:title="Clear App Content" />