Latent TB Infection: Treatment Choosing the Most Effective Regimen

Latent TB Infection: Guide for Diagnosis and Treatment

Treatment

Choosing the Most Effective Regimen

There are several treatment regimens available for the treatment of latent TB infection (LTBI). Providers should choose the appropriate regimen based on the following:

• Drug-susceptibility results of the presumed source case (if known)
• Coexisting medical illness; and
• Potential for drug-drug interactions

LTBI Treatment Regimens

View Table in separate page.

Drug(s)	Duration	Dose	Frequency	Total Doses
Isoniazid (INH)	9 months	Adult: 5 mg/kg  Children: 10-20 mg/kg** Maximum dose: 300 mg	Daily	270
		Adult:15 mg/kg  Children: 20-40 mg/kg** Maximum dose: 900 mg	Twice weekly†	76
	6 months	Adult: 5 mg/kg  Children: Not recommended Maximum dose: 300 mg	Daily	180
		Adult: 15 mg/kg  Children: Not recommended Maximum dose: 900 mg	Twice weekly†	52
Isoniazid (INH) and Rifapentine (RPT)	3 months	Adults and Children 12 and over:  INH*:15 mg/kg rounded up to the nearest 50 or 100 mg; 900 mg maximum  RPT*:  10.0–14.0 kg  300 mg  14.1–25.0 kg  450 mg  25.1–32.0 kg  600 mg  32.1–49.9 kg  750 mg  ≥ 50.0 kg 900 mg maximum	Once weekly†	12
Rifampin (RIF)	4 months	Adult: 10 mg/kg***  Maximum dose: 600 mg	Daily	120

†Intermittent regimens must be provided via directly observed therapy (DOT), i.e., health care worker observes the ingestion of medication.

*Isoniazid (INH) is formulated as 100 mg and 300 mg tablets. Rifapentine (RPT) is formulated as 150 mg tablets in blister packs that should be kept sealed until usage.

** The American Academy of Pediatrics recommends an INH dosage of 10-15 mg/kg for the daily regimen and 20-30 mg/kg for the twice weekly regimen.

***In the United States, the recommended regimen for treatment of LTBI in children is a 9-month course of INH. For the treatment of LTBI in infants, children, and adolescents when INH could not be tolerated or the child has had contact with a case patient infected with an isoniazid-resistant but rifamycin-susceptible organism the American Academy of Pediatrics recommends 6 months of daily rifampin (RIF) (180 doses) at a dosage of 10-20 mg/kg.