Treatment Regimens for Latent TB Infection (LTBI)

The four treatment regimens for latent TB infection (LTBI) use isoniazid (INH), rifapentine (RPT), or rifampin (RIF). While all the regimens are effective, healthcare providers should prescribe the more convenient shorter regimens, when possible. Patients are more likely to complete shorter treatment regimens.

Treatment must be modified if the patient is a contact of an individual with drug-resistant TB disease. Consultation with a TB expert is advised if the known source of TB infection has drug-resistant TB.

CDC has updated the recommendations for use of once-weekly isoniazid-rifapentine for 12 weeks (3HP) for treatment of latent TB infection.

Latent TB Infection Treatment Regimens

Latent TB Infection Treatment Regimens
Drugs	Duration	Interval	Comments
Isoniazid and Rifapentine	3 months	Once weekly*	Not recommended for persons who are: Less than 2 years old, Living with HIV/AIDS and taking antiretroviral medications with clinically significant or unknown drug interactions with rifapentine, Presumed infected with INH- or RIF-resistant M. tuberculosis, and Women who are pregnant or expect to become pregnant within the 12 week regimen.
Rifampin	4 months	Daily	Not recommended for persons who are: Living with HIV/AIDS and taking antiretroviral medications with clinically significant or unknown drug interactions with rifampin (rifabutin may be used as a substitute), Presumed infected with RIF-resistant M. tuberculosis, and Women who are pregnant or expect to become pregnant within the 4 month regimen.
Isoniazid	6 months	Daily	Not recommended for persons who are presumed infected with INH-resistant M. tuberculosis.
Isoniazid	6 months	Twice weekly**	Not recommended for persons who are presumed infected with INH-resistant M. tuberculosis.
Isoniazid	9 months	Daily	Not recommended for persons who are presumed infected with INH-resistant M. tuberculosis. Preferred treatment for: Persons living with HIV AIDS and taking antiretroviral medications with clinically significant or unknown drug interactions with once-weekly rifapentine or daily rifampin, Pregnant women (with pyridoxine/vitamin B6 supplements)
Isoniazid	9 months	Twice weekly**	Not recommended for persons who are presumed infected with INH-resistant M. tuberculosis. Preferred treatment for pregnant women (with pyridoxine/vitamin B6 supplements)

*Use Directly Observed Therapy (DOT) or Self-Administered Therapy (parentally-administered SAT to children)

**Use Directly Observed Therapy (DOT)

Note: Due to the reports of severe liver injury and deaths, CDC recommends that the combination of rifampin (RIF) and pyrazinamide (PZA) should not be offered for the treatment of latent TB infection.