From the Guidelines
The recommended treatment for a patient with a positive Quantiferon Gold test indicating Latent Tuberculosis Infection (LTBI) is one of several regimens, with the preferred option being 3 months of once-weekly isoniazid plus rifapentine (3HP), as recommended by the National Tuberculosis Controllers Association and CDC in 2020 1. This regimen consists of isoniazid 15 mg/kg (maximum 900 mg) plus rifapentine 600-900 mg (weight-based) taken once weekly for 12 weeks under direct observation. Alternative regimens include:
- 4 months of daily rifampin (10 mg/kg, maximum 600 mg daily)
- 3 months of daily isoniazid plus rifampin
- 6-9 months of daily isoniazid (5 mg/kg, maximum 300 mg daily) Before starting treatment, patients should undergo baseline liver function tests and be evaluated for potential drug interactions, particularly with rifampin-containing regimens, as noted in the guidelines 1. Monthly clinical monitoring for adverse effects is essential, with more frequent liver function testing for those with risk factors for hepatotoxicity. Treatment is particularly important for individuals with recent TB exposure, HIV infection, immunosuppression, or those planning to start immunosuppressive therapy, as they have higher risk of progression to active TB, as highlighted in the guidelines 1. The goal of LTBI treatment is to prevent progression to active tuberculosis disease by eliminating dormant bacteria before they can reactivate and cause illness or transmission to others. It is worth noting that the 2020 guidelines from the National Tuberculosis Controllers Association and CDC provide the most up-to-date recommendations for the treatment of LTBI, and should be followed in clinical practice 1.
From the FDA Drug Label
PRIFTIN is indicated in adults and children 2 years and older for the treatment of latent tuberculosis infection caused by Mycobacterium tuberculosis in patients at high risk of progression to tuberculosis disease PRIFTIN must always be used in combination with isoniazid as a 12-week once-weekly regimen for the treatment of latent tuberculosis infection
The recommended treatment for a patient with a positive Quantiferon Gold test result indicating Latent Tuberculosis Infection (LTBI) is rifapentine (PRIFTIN) in combination with isoniazid as a 12-week once-weekly regimen 2.
- Key points:
- Patient population: Adults and children 2 years and older
- Treatment regimen: 12-week once-weekly regimen
- Combination therapy: Rifapentine (PRIFTIN) with isoniazid
- Important consideration: Active tuberculosis disease should be ruled out before initiating treatment for latent tuberculosis infection 2.
From the Research
Treatment Options for Latent Tuberculosis Infection (LTBI)
- The recommended treatment for a patient with a positive Quantiferon Gold test result indicating LTBI is typically a regimen of antibiotics to prevent the development of active tuberculosis [(3,4,5,6)].
- The most commonly recommended regimens include:
- 9 months of isoniazid daily [(3,5,6)]
- 4 months of rifampin 5
- 3 months of weekly isoniazid and rifapentine (3HP) [(3,5,6)]
Efficacy and Safety of Treatment Regimens
- The 3HP regimen has been shown to be as effective as other regimens in preventing the development of active tuberculosis, with higher treatment completion rates [(5,6)].
- The 3HP regimen is also associated with a lower risk of hepatotoxicity compared to other regimens 3.
- However, the choice of treatment regimen should be individualized based on patient factors, such as liver function and ability to tolerate therapy [(3,5)].
Monitoring and Follow-up
- Patients with LTBI should be monitored for the development of active tuberculosis, and follow-up testing with the Quantiferon Gold test may be necessary [(4,7)].
- However, the Quantiferon Gold test should not be used to monitor the effect of preventive therapy, as most patients will remain positive after treatment 4.