Latent Tuberculosis infection (LTBI)

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Regimens for treatment of tuberculosis infection (latent tuberculosis) in nonpregnant adults without HIV*

For treatment of TB infection in most nonpregnant adults without human immunodeficiency virus (HIV) infection, a rifamycin-based regimen is preferred over isoniazid (INH) monotherapy (Grade 2B) given the efficacy, favorable treatment completion rates, and relatively low hepatotoxicity rates of rifamycin-based regimens. The choice of regimen is based on administration schedule and expected toxicity. For any regimen, directly observed therapy may improve adherence.[1]

Rifamycins have drug interactions with many common medications; consult the drug interactions program to identify and manage potential interactions. Regimens that include INH may be administered with pyridoxine supplementation (25 to 50 mg daily) to prevent INH-induced peripheral neuropathy. [1]

Rifampin (4R) — The efficacy of 4R for reducing the incidence of TB disease is estimated to be similar to that of INH monotherapy; 4R regimen is well tolerated, with good completion rates and a low rate of hepatotoxicity. This was illustrated in a randomized trial including more than 6800 adults with TBI treated with 4R or 9H; 4R was not inferior to 9H for prevention of TB disease (<0.01 cases per 100 person-years in both groups) and was associated with a higher rate of treatment completion (79 versus 63 percent) and lower rate of adverse events (rate difference -1.1 percentage points for all events; 95% CI -1.9 to -0.4). RIF was associated with "rash or other allergy" in 0.2 percent of patients treated with 4R.[1]

In addition, the cost for administration of 4R is lower than that of 9H. In one study including more than 6000 adults and 800 children, the ratios of costs for 4R versus 9H were 0.76 (95% CI 0.70-0.82) in high-income countries, 0.90 (95% CI 0.85-0.96) in middle-income countries, and 0.80 (95% CI 0.78-0.81) in African countries [1].