Alternatives to 3HP Treatment for Latent Tuberculosis Infection

Preferred Alternative Regimens

The Centers for Disease Control and Prevention recommends 4 months of daily rifampin as a strongly recommended regimen for HIV-negative adults and children of all ages, due to its excellent effectiveness, safety, and high treatment completion rates 3
The Centers for Disease Control and Prevention suggests that 4 months of daily rifampin has clinically equivalent effectiveness to 9 months of isoniazid with less toxicity, and is noninferior in preventing TB disease compared to 9 months of isoniazid 3
The European Respiratory Society notes that 4 months of daily rifampin has a lower hepatotoxicity risk, with an odds ratio of 0.03 compared to 6 months of isoniazid 4
The Centers for Disease Control and Prevention conditionally recommends 3 months of daily isoniazid plus rifampin for both HIV-negative and HIV-positive individuals, with similar risk for TB disease, hepatotoxicity, and adverse effects requiring discontinuation compared to ≥6 months of isoniazid 3, 5

The Centers for Disease Control and Prevention recommends 6 months of daily isoniazid as an alternative regimen with strong recommendation for HIV-negative individuals, but with conditional recommendation for HIV-positive individuals due to higher toxicity risk and lower treatment completion rates 3, 5
The European Respiratory Society notes that 9 months of daily isoniazid has optimal protection from isoniazid, but with higher toxicity risk and lower completion rates than rifamycin-based regimens 4

The Centers for Disease Control and Prevention warns that drug interactions are a significant concern with rifamycin-based regimens, including interactions with warfarin, oral contraceptives, azole antifungals, and HIV antiretroviral therapy 1, 5
The Centers for Disease Control and Prevention suggests that rifabutin has fewer drug interactions and may be used when rifampin is contraindicated and isoniazid cannot be used 5

The European Respiratory Society does not recommend pyrazinamide-containing regimens due to high documented toxicity 4
The Centers for Disease Control and Prevention does not recommend the 2-month regimen of rifampin plus pyrazinamide due to risk of severe hepatotoxicity 6