American Board of Internal Medicine (ABIM) Certification Practice Exam

In what circumstance may rifampin be especially preferred for latent TB treatment?

1. History of liver disease

2. Hypersensitivity to isoniazid

3. Previous isoniazid treatment

4. Presence of pulmonary nodules

The correct answer is: Hypersensitivity to isoniazid

Rifampin is particularly preferred for latent tuberculosis (TB) treatment when a patient has a hypersensitivity to isoniazid. This is significant because isoniazid is one of the primary medications used for treating latent TB. If a patient cannot tolerate isoniazid due to hypersensitivity reactions, rifampin becomes a suitable alternative to ensure that the latent TB infection is addressed effectively. In cases of previous isoniazid treatment, the choice of rifampin may not be as straightforward unless there were complications such as hypersensitivity. The presence of pulmonary nodules can indicate active disease or other complications that may not be suitable for just rifampin treatment and typically would require further assessment and possibly different management strategies. Lastly, a history of liver disease complicates matters, as both isoniazid and rifampin can be hepatotoxic, but isoniazid is particularly known for its potential to affect liver function; thus, this scenario requires careful consideration of all treatment options rather than simply preferring rifampin. Choosing rifampin in the context of hypersensitivity to isoniazid ensures that treatment for latent TB can continue in a patient who would otherwise be unable to take the standard recommended therapy.