TABLE 4.
Current guidelines for the treatment of latent tuberculosis infectiona
| Institution (year) | Recommended treatment for LTBI that is presumed to be drug susceptible | Recommended treatment for LTBI that is presumed to be MDR |
|---|---|---|
| WHO (2014) (6) | 6INH or 9INH or | Strict clinical observation for 2 yrs is preferred over provision of preventive therapy. Benefits of preventive therapy may outweigh harm for children <5 yrs of age. If preventive therapy is given, monitor for acquired drug resistance. |
| 3 mo of wkly RPT plus INH under DOT or | ||
| 3–4 mo of INH + RIF or | ||
| 3–4 mo of RIF | ||
| CDC (2000) (8) | 9INH daily or twice wkly | Not stated |
| 6INH daily or twice wkly | ||
| 4RIF dailyb | ||
| 3 mo of wkly RPT + INH under DOT (if HIV positive, 9 mo is preferred) | ||
| UK NICEc guidelines (2016) (37) | Close contacts aged <65 yrs or HIV positive: either 6INH (with pyridoxine) or 3 mo of INH + RIF (with pyridoxine) | Not stated |
| Close contacts aged <35 yrs for whom hepatotoxicity is a concern: 3 mo of INH + RIF (with pyridoxine) | ||
| For people living with HIV and for transplant recipients: 6INH (with pyridoxine) | ||
| Canadian TB Standards (2013) (37) | 9 mo of INH (first choice) | INH-R: treat contacts of patients with INH resistance with 4RIF. RIF-R: contacts with RIF resistance with 9INH.MDR-TB: 9LFX or 9MOX with close monitoring. |
| Alternative regimens:6INH3–4 of mo INH + RIF3 mo of wkly INH/RPT under DOT; intermittent regimens only recommended when daily regimens cannot be used (6-9INH twice wkly; 3 mo of INH + RIF twice wkly; under DOT)d |
This table has been adapted from the work of Fox et al. (185). Note that the European Union Standards for TB Care are not included as they have not been updated since 2012, and the WHO guidelines apply to these countries. The duration of treatment is indicated by the number of months followed by the drug name (e.g., 6INH is 6 months of isoniazid). Treatment is given daily under self-administered therapy unless otherwise stated. DOT, directly observed therapy; INH, isoniazid; RIF, rifampin; RPT, rifapentine; LFX, levofloxacin; MOX, moxifloxacin.
ATS guidelines previously recommended rifampin with pyrazinamide for 2 months; however, this is no longer recommended on account of high rates of hepatotoxicity after implementation (53).
The UK National Institute for Health and Care Excellence (NICE) guidelines recommend that preventive therapy be offered to 35- to 65-year-olds if hepatotoxicity is not a concern.
In pregnancy, deferral of preventive therapy until 3 months after delivery is recommended unless there is a very high risk of disease (e.g., HIV or recent infection). Isoniazid (with pyridoxine) and rifampin are considered safe in pregnancy (45).