Drug Interaction:
Drug Interactions- summary-
Corticosteroids or immunosuppressants -
reactivity to the test may be depressed or suppressed for upto 6 week in individuals who are
receiving corticosteroids or immunosuppreressive agents
Live viral vaccines -
reactivity may be temporarily depressed by certain live virus vaccines( measles, mumps,
rubella, oral polio, yellow fever and varicella )
Indication:
Tuberculosis ( TB ) skin test
Adverse Reaction:
Local -
Very rare- vesiculation, ulceration or necrosis, may appear at the test site in highly sensitive
persons. Cold packs or topical steroid preparations may be employed for symptomatic
relief of associated pain, pruritus and discomfort.
Uncommon- immediate erythematous or other reactions may occur at the injection site.
Systemic- rare sytemic allergic reactions reported- manifested by immediate skin rash,
or generalized rash, within 24 hours. Rections were treated with epinephrine and steroids
and resolved .
Contra-Indications:
Allergy to any of the component
Special Precautions/warnings-
SC injection - avoid injecting tuberculin PPD ( Mantoux ) SC. If this occurs, no local reaction will develop, and the test cannot be interpreted
False -negative reactions- anything that impairs or attentuates cell- mediated imunity (CMI ) potential can cause a false negative tuberculin reaction ( viral infections , particularly
HIV , live virus vaccines, severe protein nutrition, lynphoma, leukemia, sarcoidosis, use
of glucocorticosteroids and other imunosuppresants drugs)
HIV infection- because active disease can develop rapidly in HIV infected persons, the
highest priority for contact investigation should be given to persons potentially coinfected
with HIV and TB.
Active TB- tuberculin PPD ( mantoux ) should be adminstered wth caution or not at all in
persons documented active tuberculosis or documented treatment in the past because
of the severity of reactions ( vesuculation, ulceration, necrosis ) that may appear at the
test site.
Sterile technique - a separate syringe needle must be used in each individual injection
to prevent the possibilty of transmission of viral hepatitis or other infections agents from
one person to another.
Administration- special care must be taken to ensure that the product is given intradermally and on the volar aspect of the forearm. Do not adminster IV, IM, or SC.
Pregnancy - Before prescribing , consider if the potential benefits outweigh the potential risk for performing the tuberculin test on a pregnant woman or a woman of child bearing age
Lactation- there is no reason to withhold breast-feeding after tuberculosis skin testing
or to avoid skin testing in breast feeding mothers.
Children- there is no age contraindication to tuberculin skin testing of infants
Very young children are at an increased risk for active tuberculosis once infected,
Therfore during contact investigation, priority with regards to skin testing and evaluation for
preventive therapy should be given to infants and young children who have been exposed
with persons with active tuberculosis
Dosages/ Overdosage Etc:
Indication-
Tuberculosis ( TB ) skin test
Dosage-
The Mantoux test is performed by injecting intradermally with a syringe and needle,
0.1ml of tuberculin purified protein derivative (Mantoux ) .
For the intradermal ( Mantoux ) tuberculin test, the dose is 5US units (TU) per
test dose of 0.1ml.
Patient Information:
1. Instruct patients to report to their doctor any adverse reactions eg. vasiculation,
ulceration,or necrosis which appear at the test site in highly sensitive patients
2. Inform patients that pain, pruritus and discomfort at the site may occur.
3. Inform patients of the need to return for the reading of test. Self reading of the test
has been shown to be unreliable.
4. Inform patients of the need to maintain a personal immuniaztion record.
Ref - USP PDI Vol II 17th Edition (1997)
TUBERCULIN PURIFIED PROTEIN DERIVATIVE (PPD)- INJECTION
1.Allergies-
Tell your doctor if you have ever had any unusual or allergic reaction to
Tuberculin (PPD). Also tell your healthcare care professional if you are
allergic to any other substances such as foods. preservatives or dyes.
2.Pregnancy-
Studies have not been done in humans or animals. However, pregnancy
may affect your reaction to the test. Before you receive tuberculin PPD,
make sure your doctor knows if you are pregnant or if you may become
pregnant.
3. Breast-feeding-
It is not known whether PPD passes into breast milk. However, tuberculin PPD
has not been reported to cause problems in nursing babies.
4.Children-
Although there is no specific information comparing use of PPD in children
with use in other age groups, this diagnostic test is not expected to cause
different side effects or problems than it does in adults.
5.Older adults-
Reaction to tuberculin PPD in older patients may be more likely to develop
slowly and may not reach the peak effect until after 72 hours.
6. Other medicines-
Tell your doctor if you are using any other prescription or non-prescription
(Over-the counter) OTC medicine, including steroids
7. Other medical problems-
The presence of other medical problems may affect the use of PPD..
Make sure you tell your doctor if you have any other medical problems
especially-
Positive tuberculin reaction ( previous)- the reaction of tuberculin PPD
may be severe, possibly causing sores on the skin where the test is given
Pregnancy and lactation:
Pregnancy -
Before prescribing , consider if the potential benefits outweigh the potential risk
for performing the tuberculin test on a pregnant woman or a woman of child bearing age
Lactation-
There is no reason to withhold breast-feeding after tuberculosis skin testing
or to avoid skin testing in breast feeding mothers.
Children-
There is no age contrindication to tuberculin skin testing of infants
Very young children are at an increased risk for active tuberculosis once infected,
Therfore during contact investigation, priority with regards to skin testing and evaluation for
preventive therapy should be given to infants and young children who have been exposed
with persons with active tuberculosis,
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