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—Dr Carlen's letter quite correctly discusses the indications for isoniazid prophylaxis in close contacts of children with tuberculosis whose initial tuberculin tests are negative. The article to which he is referring was discussing the interpretation of tuberculin testing in elderly patients and not the indications for isoniazid prophylaxis, especially in children. I certainly agree that children, particularly infants, should receive isoniazid prophylaxis if they are close contacts of patients with tuberculosis, regardless of their initial tuberculin test results. Although one could argue this point for adults, it seems reasonable to begin isoniazid prophylaxis initially and repeat the tuberculin test in 4 to 6 weeks and judge continuation of treatment at that point.
Lefrak SS. Tuberculosis Screening and Indications for Preventive Therapy-Reply. JAMA. 1992;267(7):932. doi:10.1001/jama.1992.03480070048021