Using the U.S. Public Health Service system, CDC and ATS have ranked these regimens according to the strength of the recommendation and the quality of supporting evidence
* Strength of recommendation: A = preferred; B = acceptable alternative; C = offer when A and B cannot be given; D = should generally not be offered
† Quality of supporting evidence: I = randomized clinical trial data; II = data from clinical trials that are not randomized or were conducted in other populations; III = expert opinion
Monitoring During Treatment
Baseline and routine laboratory monitoring during treatment of LTBI are indicated only when there is a history of liver disease, HIV infection, pregnancy (or within 3 months post delivery), or regular alcohol use. Baseline hepatic measurements of serum AST, ALT, and bilirubin are used in the situations mentioned above and to evaluate symptoms of hepatotoxicity.
Clinical monitoring, including a brief physical examination, should occur at monthly visits to assess adherence and identify signs or symptoms of adverse drug reactions.
Obtain a list of patient’s current medications to avoid drug interactions. Some interactions to note:
Patients on treatment for LTBI should be instructed to report any potential medication side effects to their health care provider, including
*Advise patients taking RIF that they will notice a normal orange discoloration of body fluids. Contact lenses may be permanently stained.
ATS/CDC. Targeted tuberculin testing and treatment of latent tuberculosis infection. MMWR 2000;49 (No. RR- 6).
ATS/CDC. Update: Adverse Event Data and Revised American Thoracic Society/CDC Recommendations Against the Use of Rifampin and Pyrazinamide for Treatment of Latent Tuberculosis Infection. MMWR 2003; 52 (No. 31).
ATS/CDC. Treatment of tuberculosis. MMWR 2003;52 (No. RR-11).
Guidelines for the Use of Rifamycins for the Treatment of Tuberculosis
Among HIV-Infected Patients Taking Protease Inhibitors or Nonnucleoside
Reverse Transcriptase Inhibitors. MMWR 2004: 53 (No.
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Division of Tuberculosis Elimination
Centers for Disease Control & Prevention