Figure 1028

The treatment of tuberculosis (TB) depends on the clinical presentation. Pretransplant prophylaxis for a positive purified protein derivative, if given, is with isoniazid 300 mg/d up to, or following, transplantation. Post-transplant treatment is more accepted, but due to the possible high rate of hepatotoxicity, many centers have chosen not to administer prophylaxis. Treatment of pulmonary disease should include at least two to three drugs (depending on resistance patterns in the area) for 6 to 9 months. Treatment of disseminated disease or extrapulmonary disease should include three or four drugs for 12 to 18 months. When starting treatment with isoniazid and rifampicin, care should be taken to increase the glucocorticoid dose twofold and the cyclosporine by threefold to fivefold. This is because rifampicin (and somewhat isoniazid) induces the metabolism of steroids and cyclosporine and FK506 through the P450 cytochrome system. (Adapted from Med Lett Drugs Ther [8]; with permission.)

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