Treatment of Latent Tuberculosis Infection
First-Line Treatment Options
- The Centers for Disease Control and Prevention recommends 9-month isoniazid (9H) as the preferred regimen for most patients, with efficacy of more than 90% when completed properly 1, 3
- The American Thoracic Society suggests that 9H can be administered daily self-administered or twice weekly under directly observed therapy (DOT) 2, 3
- A 6-month isoniazid regimen provides substantial protection, but the 9-month regimen offers optimal protection and is preferred for individual patients 3, 4
Alternative Regimens
- The American Thoracic Society recommends 4-month rifampin (4R) for patients who cannot tolerate isoniazid or pyrazinamide 5, 6
- The Centers for Disease Control and Prevention suggests 2-month rifampin plus pyrazinamide (2RZ) for HIV-infected persons based on randomized trials 1, 3
- The American Thoracic Society notes that the 2RZ regimen should be used with caution in HIV-negative individuals due to increased risk of hepatotoxicity 3, 7
Special Populations Considerations
- The Centers for Disease Control and Prevention recommends 9 months of isoniazid for HIV-infected persons, rather than 6 months 2, 5
- The American Thoracic Society suggests that 2-month daily rifampin and pyrazinamide regimen is particularly effective in HIV-infected persons 3
- The Centers for Disease Control and Prevention recommends isoniazid for 9 months for children and adolescents 2, 5
- The American Thoracic Society suggests that for pregnant, HIV-negative women, isoniazid for 9 or 6 months is recommended 2, 5
Monitoring During Treatment
- The Centers for Disease Control and Prevention recommends that before starting treatment, active TB must be ruled out through history, physical examination, chest radiography, and when indicated, bacteriologic studies 4
- The American Thoracic Society suggests that clinical evaluations should be performed at least monthly for patients on isoniazid or rifampin alone 5
- The Centers for Disease Control and Prevention recommends baseline laboratory testing for patients with suspected liver disorders, HIV-infected persons, pregnant women, and women in the immediate postpartum period 5