Table 5– Comparison of recommendations of published national guidelines and of this TBNET consensus statement
Country/study [ref.]#Risk assessment examination CXRTSTTST detailsPositive TSTIGRA testingWho should receive prophylaxis?LTBI treatmentTime delay before TNF antagonist therapy
LTBIActive TB
France 116All patientsAll patientsOne step10 mmNoTST+, history of TB treated before 1970 or not treated for min. 6 months; CXR lesions >1 cm3 with no history of treatment2RZ 3RH 9H>3 weeks after starting prophylaxis>2 months after completion of TB treatment
Germany 177All patientsOnly if discrepancy between strong epidemiological evidence of prior TB exposure and negative IGRA>5 mmYesIGRA+, abnormal CXR suggestive of past TB inadequately treated; history of exposure9H or 4R1–2 months after starting prophylaxis
Ireland 117All patientsAll patientsOne step10 mm, 5 mm for IS, no change for BCG vaccinatedIf availableTST+9H 4R 4RHAs long as possible after starting prophylaxisOn completion of TB treatment
Portugal 107All patientsAll patientsTwo step5 mmIn progressTST+, consider prophylactic treatment in TST-negative patients9H1 month on prophylaxis>2 months on TB treatment
Spain 7, 115All patientsAll patientsTwo step5 mmNoTST+, abnormal CXR suggestive of past TB inadequately treated; history of exposure9H1 month but consider days after or at same time as starting prophylaxis
Switzerland 20All patientsNot recommendedYesIGRA+, abnormal CXR suggestive of past TB inadequately treated; history of exposure9H or 4R1 month after completion of prophylaxis
UK 113All patientsNot for patients on IS as unreliableOne step5 mm in unvaccinated, 15 mm in vaccinatedNo (update due 2010 by NICE)TST+ stratified for risk; previous TB inadequately treated or abnormal CXR; IS patients stratified for risk6H or 3HRIf abnormal CXR or history of TB, complete prophylaxis. If normal CXR or IS can start concurrently>2 months on TB treatment
USA 114All patientsAll patientsOne step5 mm if IS, 10 mm if risks, e.g. new immigrant, drug users 15 mm if low riskNoTST+ in presence of clinical suspicion, TST- if clinical or epidemiological risks9HPreferably complete prophylaxisPreferably complete TB treatment
TBNET consensus statementAll patientsTST in individuals without a history of BCG vaccinationOne step≥10 mmYesIGRA+ or TST ≥10 mm9–12H or 3 RH>4 weeks after initiation of prophylaxisPreferably complete TB treatment
  • CXR: chest radiograph; TST: tuberculin skin test; IGRA: interferon-γ release assay; LTBI: latent infection with Mycobacterium tuberculosis; TNF: tumour necrosis factor; TB: tuberculosis; IS: immunosuppressed/immunosuppression; BCG: bacille Calmette–Guérin; NICE: National Institute for Clinical Excellence; min.: minimum; RZ: rifampicin plus pyrazinamide; RH: rifampicin plus isoniazid; H: isoniazid: R: rifampicin. #: screening pre-TNF antagonist therapy; : the number denotes the number of months of LTBI treatment.