DAVID N. ROSE, M.D.; ALAN L. SILVER, M.D., M.P.H.; CLYDE B. SCHECHTER, M.D., M.A.
To the editor: Stead and colleagues (1) have provided valuable evidence documenting the incidence of isoniazid-induced hepatitis and the effectiveness of isoniazid chemoprophylaxis in elderly persons. Their findings support the use of isoniazid in high-risk tuberculin reactors, such as recent converters, even older persons.
Two methodologic assumptions were used that led to an underestimation of the benefit-risk ratio of isoniazid chemoprophylaxis: The benefit-risk ratio was calculated with an unstated observation period, and also by comparing cases of tuberculosis and isoniazid-induced hepatitis. These issues are especially important in the decision regarding isoniazid use in low-risk tuberculin reactors. These persons have positive
ROSE DN, SILVER AL, SCHECHTER CB. Preventive Treatment for Tuberculosis in Elderly Persons. Ann Intern Med. ;108:908–909. doi: 10.7326/0003-4819-108-6-908_2
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Published: Ann Intern Med. 1988;108(6):908-909.
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