All members of a newly arrived immigrant family from a third-world country have received positive tuberculosis skin test results. The family consists of parents, a 2-year-old, and a 7-year-old

Question

Which therapy regimen does the family practice nurse coordinate for this family?
A.
A course of intravenous pyrazinamide (PZA) given once a month in the clinic
B.
Directly observed therapy with isoniazid (INH) and rifampin (Rifadin) for 9 months
C.
Isoniazid and rifampin once a week for 6 months, given by the nurse in the clinic
D.
Isoniazid daily for 9 months, followed by rifampin once a week for 3 months

Answer 1

ANS: B
Because the duration of therapy for TB is so long, noncompliance is an issue that must be addressed by the nurse. Directly observed therapy (DOT) helps with compliance, which reduces relapses, treatment failure, and drug resistance, especially in children and adolescents. Because all members of the family must take the medication, and because they are immigrants who may have limited English proficiency, limited health literacy, and perhaps values and beliefs that contradict Western medical care, directly observed therapy is vital to ensure cure and to prevent spread of the disease. Drugs used include isoniazid and rifampin for 9 months. Pyrazinamide can be added, decreasing the treatment time to 6 months.