Update of Treatment Recommendations for Latent Mycobacterium tuberculosis Infection

An update from the CDC recommends broadening the population that can use once-weekly isoniazid plus rifapentine for LMTI.

Sponsoring Organization: Centers for Disease Control and Prevention (CDC) in consultation with members of the Advisory Council for the Elimination of Tuberculosis (ACET)

Target Audience: Healthcare workers who treat latent tuberculosis in adults and children, including immune-deficient patients

Background and Objective

Treatment of latent tuberculosis is critical in preventing reactivation of infection. Several regimens have been used in the past. The CDC has reassessed treatment options periodically to minimize the number of drugs used and treatment duration. In 2011, the CDC recommended a 12-week course of once-weekly isoniazid and rifapentine (3HP). This update reexamines and extends that recommendation. Data are derived from a meta-analysis of 19 articles covering 15 different studies.

Key Points

• The 3HP regimen remains the CDC recommendation for treatment of latent tuberculosis in adults.
• The 3HP regimen is now also recommended for adults living with HIV infection, including those with AIDS, and those on antiretroviral regimens that do not interact adversely with rifapentine. Healthcare workers should be well versed in caring for patients with both diseases.
• This regimen is now recommended for treatment of children aged 2 to 17 years as well as adults.
• Use of the 3HP regimen administered by directly observed therapy (DOT; previously the only recommended method) or self-administered therapy (SAT) in patients ≥2 years of age is acceptable. Although DOT may be more reliable, this is offset by the lower expense and high completion rate of SAT. Use of SAT should be based on assessment of environmental and patient-related factors.
• As with all drug regimens, patients should be monitored for drug-related adverse events and for activation of tuberculosis.

What’s Changed

The population in which this regimen can be used is greatly expanded (to those with HIV infection not treated with incompatible drugs, to children as young as 2 years, and with broader use of SAT), while maintaining safety.

Comment

These new recommendations reinforce the previously observed efficacy of a very short course of a two-drug regimen in treating latent tuberculosis. One can hope that widespread use will markedly decrease the worldwide burden of a disease that causes substantial morbidity and mortality.