Treatment of Latent Tuberculosis Infection in Immunocompromised Patients

Recommended Regimens

• The Centers for Disease Control and Prevention recommends a 4-month daily regimen of rifampin for patients who cannot tolerate isoniazid or pyrazinamide, with similar efficacy to INH but better safety profile 1, 2
• For patients with chronic conditions that may increase the risk for liver disease, baseline liver function tests should be obtained before initiating treatment, and monthly clinical evaluations should be performed when receiving rifampin alone 1, 2, 3, 4

Monitoring and Management

• Before initiating treatment, it is essential to rule out active TB through history, physical examination, chest radiography, and when indicated, bacteriologic studies, as recommended by the Centers for Disease Control and Prevention 1, 2
• During treatment, assessment for side effects and brief physical examination checking for signs of hepatitis should be performed, along with patient education regarding potential side effects and when to seek medical attention 3, 4
• If rifampin cannot be used due to drug interactions, consider 9 months of isoniazid with close monitoring of liver function, as suggested by the American Journal of Respiratory and Critical Care Medicine and MMWR Recommendations and Reports 1, 2