Tuberculosis (TB) Guidelines

Updated: Jun 04, 2020
  • Author: Thomas E Herchline, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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Guidelines

Latent Tuberculosis Infection (LTBI) Treatment Guidelines

The National Tuberculosis Controllers Association (NTCA) and Centers for Disease Control and Prevention (CDC) have issued updated treatment guidelines for latent tuberculosis infection (LTBI) among persons who live in the United States. [93]

The recommended 2020 LTBI treatment guidelines include three preferred rifamycin-based regimens and two alternative daily-isoniazid monotherapy regimens. These recommendations are intended for Mycobacterium tuberculosis infections with presumed susceptibility to isoniazid or rifampin. M tuberculosis strains that are resistant to both isoniazid and rifampin are exempt from these recommendations.

Generally, rifamycin-based treatment regimens administered in short courses are preferred over isoniazid monotherapy administered in longer courses for the treatment of LTBI.

Preferred treatment regimens for LTBI

The rifamycin-based preferred regimens for LTBI are as follows:

  • Once-weekly isoniazid plus rifapentine for 3 months (strongly recommended in adults and children >2 years, including those with HIV infection) OR
  • Daily rifampin for 4 months (strongly recommended in HIV-negative adults and children of all ages) OR
  • Daily isoniazid plus rifampin for 3 months (conditionally recommended in adults and children of all ages and in HIV-positive persons)

Prescribing providers or pharmacists should note that rifampin and rifapentine are not interchangeable, and care should be taken to administer the correct medication for the intended regimen.

Alternative treatment regimens for LTBI

The alternative treatment regimens are as follows:

  • Daily isoniazid for 6 months (strongly recommended in HIV-negative adults and children of all ages and conditionally in HIV-positive adults and children of all ages) OR
  • Daily isoniazid for 9 months (conditionally recommended in adults and children of all ages regardless of HIV infection status)