ATS GUIDELINES Bundle

7 For the management of contacts to patients with MDR-TB: ➤ We suggest offering treatment for latent TB infection (LTBI) for contacts to patients with MDR-TB versus following with observation alone (conditional recommendation, very low certainty in the evidence). We suggest 6–12 months of treatment with a later- generation fluoroquinolone alone or with a second drug, on the basis of drug susceptibility of the source-case M. tuberculosis isolate. On the basis of evidence of increased toxicity, adverse events, and discontinuations, pyrazinamide should not be routinely used as the second drug. Grading of Recommendations, Assessment, Development, and Evaluation (GRADE)-Based Recommendations Implications for: Strong Recommendation Conditional Recommendation Patients e overwhelming majority of individuals in this situation would want the recommended course of action and only a small minority would not. e majority individuals in this situation would want the suggested course of action, but a sizeable minority would not. Clinicians e overwhelming majority of individuals should receive the recommended course of action. Adherence to this recommendation according to the guideline could be used as a quality criterion or performance indicator. Formal decision aids are not likely to be needed to help individuals make decisions consistent with their values and preferences. Different choices will be appropriate for different patients and you must help each patient arrive at a management decision consistent with her or his values and preferences. Decision aids may be useful to help individuals make decisions consistent with their values and preferences. Clinicians should expect to spend more time with patients when working towards a decision. Policy Makers e recommendation can be adapted as policy in most situations including for the use as performance indicators. Policy-making will require substantial debates and involvement of many stakeholders. Policies are also more likely to vary between regions. Performance indicators would have to focus on the fact that adequate deliberation about the management options has taken place.

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