Guidelines Updated on Treating Latent TB

By Amy Orciari Herman

Edited by André Sofair, MD, MPH

Shorter rifamycin-based regimens are preferred over longer-course isoniazid (INH) monotherapy for treating latent tuberculosis, according to new guidelines from the National Tuberculosis Controllers Association and the CDC. Evidence shows that shorter rifamycin-based regimens are similarly effective to INH monotherapy but have less hepatotoxicity and better completion rates.

The guidelines, published in MMWR Recommendations and Reports, apply only to patients infected with Mycobacterium tuberculosis that is believed susceptible to INH or rifampin. Three rifamycin-based regimens are preferred:

• Three months of once-weekly INH plus rifapentine is strongly recommended for patients aged 2 years and older, including those also infected with HIV.

• Four months of rifampin daily is strongly recommended for HIV-negative patients of all ages.

• Three months of daily INH plus rifampin is conditionally recommended for patients of all ages, including HIV-infected patients.

The guidance reminds clinicians that rifapentine and rifampin are not interchangeable.

Additionally, two INH regimens may be used as alternatives in patients who can't tolerate the shorter regimens:

• Six months of daily INH is strongly recommended for HIV-negative patients of all ages and conditionally recommended for HIV-positive patients.

• Nine months daily INH is conditionally recommended for patients of all ages, regardless of HIV status.