December 1991

Decision Analysis for Isoniazid Chemoprophylaxis-Reply

Author Affiliations

White River Junction, Vt

Arch Intern Med. 1991;151(12):2477. doi:10.1001/archinte.1991.00400120108027

In Reply. —  It appears that Berger and Rehm have misunderstood the nature of my article.1 This study did not use newly devised decision trees. It was, instead, a reanalysis of previous studies that was intended to define those conditions under which all the previous studies agreed. The conclusion of my article was that all the previous studies did agree that isoniazid chemoprophylaxis for purified protein derivative reactors less than 35 years of age without other risk factors for tuberculosis reactivation was indicated under certain conditions. The most important condition was a low isoniazid-related hepatitis case-fatality rate. The score consequently (if that is how Berger and Rehm think of things) is three favoring the American Thoracic Society/ Centers for Disease Control recommendation and zero opposed, given the favorable conditions.Berger and Rehm raise other important issues. Their point that an alternative strategy, based on no isoniazid initially but isoniazid

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