Latent TB Infection: Treatment Regimens for LTBI

Latent TB Infection: Guide for Diagnosis and Treatment

Treatment

Treatment Regimens for LTBI

Overview

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

For persons who are at especially high risk for TB disease and are either suspected of nonadherence or are given an intermittent dosing regimen, directly observed therapy (DOT) for LTBI should be considered. This method of treatment is especially appropriate if the person in need of LTBI treatment lives with a household member who is on DOT for TB disease, or lives in an institution or facility where treatment for LTBI can be observed by a staff member. It is necessary to exclude TB disease before starting LTBI treatment.

Isoniazid (INH) Regimen

There are 2 options for treatment with INH:

• 9-month regimen
• 6-month regimen

The 9-month regimen is preferred because it is more efficacious. Treatment for LTBI for 6 months rather than 9 months may be more cost-effective and result in greater adherence by patients; therefore, health care providers may prefer to implement the 6-month regimen rather than the 9-month regimen. Every effort should be made to ensure that patients adhere to LTBI treatment for at least 6 months. The preferred regimen for children aged 2 to 11 years is 9 months of daily INH.

12-Dose (Isoniazid and Rifapentine [RPT]) Regimen

The directly observed 12-dose once-weekly regimen of INH and RPT is recommended as an option equal to the standard INH 9-month daily regimen for treating LTBI in otherwise healthy people, 12 years of age and older, who were recently in contact with infectious TB, or who had tuberculin skin test or blood test for TB infection conversions, or those with radiologic findings consistent with healed pulmonary TB.

The 12-dose regimen can be considered for other groups on a case by case basis when it offers practical advantages, such as completion within a limited timeframe. The regimen may be used in otherwise healthy HIV-infected persons, 12 years of age and older, who are not on antiretroviral medications. It may also be considered for children aged 2-11 years if completion of 9 months of INH is unlikely and hazard of TB disease is great.

The 12-dose regimen is NOT recommended for the following individuals:

• Children younger than 2 years of age
• People with HIV/AIDS who are taking antiretroviral therapy (ART)
• People presumed to be infected with INH or rifampin-resistantM.tuberculosis
• Pregnant women, or women expecting to become pregnant while taking this regimen

The choice between the 12-dose regimen and other recommended LTBI treatment regimens depends on several factors, including:

• Feasibility of DOT
• Resources for drug procurement and patient monitoring
• Considerations of medical and social circumstances that could affect patient adherence
• Preferences of the patient and prescribing health care provider

Rifampin (RIF) Regimen

A 4-month regimen of RIF can be considered for persons who cannot tolerate INH or who have been exposed to INH-resistant TB. It should not be used to treat HIV-infected persons taking some combinations of ART.

Record of Treatment Completion

To Whom It May Concern: 
The following is a record of evaluation and treatment for M. tuberculosisinfection: 
Name:_________________________ Date of birth:_____________ 
TST: Date:_____________ Results (in millimeters of induration):____ 
IGRA: Date:_____________ Type of test:________ Result:_________ 
Chest radiograph: Date:____________ Results:_________________ 
Date medication started:___________ Date completed:___________ 
Medication(s):___________________________________________ 
______________________________________________________ 
This person is not infectious. He/she may always have a positive TB skin test, so there is no reason to repeat the test. If you need any further information, please contact this office. 
Signature of Provider_____________________________________ 
Date__________________________________________________