From the Guidelines
The treatment for Latent Tuberculosis (TB) is a short-course rifamycin-based treatment regimen, such as 3-4 months of rifampicin or 12 weeks of once-weekly isoniazid and rifapentine.
Treatment Options
- Rifamycin-based treatment regimens are preferred over longer-course isoniazid monotherapy for treatment of LTBI, due to higher treatment completion rates and equivalent safety and effectiveness 1.
- 3HP regimen, which consists of 12 weeks of once-weekly isoniazid and rifapentine, is a recommended treatment option for LTBI in adults and children aged 2-17 years, including those with HIV infection 2.
- Isoniazid monotherapy for 6-9 months is also an option, but it has a longer treatment duration and lower treatment completion rates compared to rifamycin-based regimens 3, 4.
Special Considerations
- HIV infection: The 3HP regimen is recommended for treatment of LTBI in persons with HIV infection, including those with acquired immunodeficiency syndrome (AIDS), who are taking antiretroviral medications with acceptable drug-drug interactions with rifapentine 2.
- Children: The 3HP regimen is recommended for treatment of LTBI in children aged 2-17 years 2.
- Pregnancy and breastfeeding: Although not explicitly mentioned in the provided evidence, it is generally recommended to consult with a healthcare provider before starting any treatment for LTBI during pregnancy or breastfeeding.
Testing and Diagnosis
- Chest radiography should be performed before LTBI treatment to rule out active TB disease 3.
- Interferon-gamma release assays or Mantoux tuberculin skin testing can be used to test for LTBI 3.
From the Research
Treatment Options for Latent Tuberculosis (TB)
The treatment of latent tuberculosis infection (LTBI) is a crucial component of TB control strategies worldwide 5, 6. The primary goal of LTBI treatment is to prevent the development of active TB disease. Several treatment options are available, including:
- Isoniazid (INH) monotherapy for 9 months, which has been the standard treatment for LTBI for almost 50 years 7
- Alternative regimens, such as 4 months of daily self-administered rifampin monotherapy, 3 months of once weekly directly observed isoniazid-rifapentine, and 3 months of daily self-administered isoniazid-rifampin, which have been shown to be as effective as INH monotherapy but with better tolerability and higher completion rates 6, 7
- A 6-month daily regimen with INH, which is also commonly used 8
- A 3-month daily regimen with INH and Rifampicin, which has been shown to have equivalent effectiveness to 6 months of INH monotherapy 7
Treatment Recommendations
The choice of treatment regimen should be individualized to the patient, taking into account factors such as the patient's risk of developing active TB, potential drug interactions, and the likelihood of adherence to treatment 6, 7. Close monitoring for potential adverse events, such as hepatotoxicity, is also essential 5, 7.
Treatment Outcomes
Treatment outcomes for LTBI have been shown to be favorable, with high completion rates and low rates of treatment interruption 8. However, challenges remain, including the need for safer, more cost-effective, and more easily completed regimens, as well as strategies to promote adherence and retain high-risk individuals in care 6.