From the Guidelines
Treating latent tuberculosis (TB) in a young, healthy patient is strongly recommended to prevent progression to active TB disease, which carries significant morbidity and mortality risks. The preferred regimen, based on the most recent and highest quality study 1, is once-weekly isoniazid-rifapentine for 12 weeks (3HP), which has been shown to be as safe and effective as other recommended LTBI regimens and achieves substantially higher treatment completion rates.
Key Considerations
- The 3HP regimen can be administered by directly observed therapy (DOT) or self-administered therapy (SAT) in persons aged ≥2 years, including those with HIV infection who are taking antiretroviral medications with acceptable drug-drug interactions with rifapentine 1.
- Before starting treatment, patients should be evaluated with a chest X-ray to rule out active TB and baseline liver function tests.
- Monthly monitoring for side effects is important, particularly watching for signs of hepatotoxicity (nausea, vomiting, abdominal pain, jaundice).
Treatment Regimens
- The 3HP regimen is the preferred treatment option, but alternative regimens include rifampin 600mg daily for 4 months, or isoniazid 300mg daily for 6-9 months.
- Patients should avoid alcohol during treatment and be educated about potential drug interactions, especially with hormonal contraceptives when taking rifamycins.
Public Health Implications
- Treating LTBI in young patients is cost-effective and represents an important public health strategy to reduce the overall burden of TB disease.
- The CDC continues to recommend 3HP for treatment of LTBI in adults and now recommends use of 3HP in persons with LTBI aged 2–17 years, and in persons with LTBI who have HIV infection, including acquired immunodeficiency syndrome (AIDS), and are taking antiretroviral medications with acceptable drug-drug interactions with rifapentine 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 Active tuberculosis disease should be ruled out before initiating treatment for latent tuberculosis infection. PRIFTIN must always be used in combination with isoniazid as a 12-week once-weekly regimen for the treatment of latent tuberculosis infection
Treatment of Latent Tuberculosis (TB) Infection should be considered in a young, healthy patient if they are at high risk of progression to tuberculosis disease.
- Key considerations for treatment include ruling out active tuberculosis disease and using PRIFTIN in combination with isoniazid as a 12-week once-weekly regimen 2.