Fact Sheets
Treatment of Latent Tuberculosis Infection
(LTBI)
Updated: July 2007
Introduction
Treatment of latent TB infection (LTBI) is essential to
controlling and eliminating TB in the United States. Treatment of
LTBI substantially reduces the risk that TB infection will progress
to disease. Certain groups are at very high risk of developing TB
disease once infected, and every effort should be made to begin
appropriate treatment and to ensure those persons complete the
entire course of treatment for LTBI.
However, if exposed and infected by a person with multidrug-resistant
TB (MDR TB) or extensively drugresistant TB (XDR TB), preventive
treatment may not be an option.
Candidates for the Treatment of LTBI
Persons in the following high-risk groups should be given
treatment for LTBI if their reaction to the Mantoux tuberculin skin
test is ≥5mm:
- HIV-infected persons
- Recent contacts of a TB case
- Persons with fibrotic changes on chest radiograph consistent
with old TB
- Patients with organ transplants
- Persons who are immunosuppressed for other reasons (e.g.,
taking the equivalent of >15 mg/day of prednisone for 1 month or
longer, taking TNF-a antagonists)
In addition, persons in the following high-risk groups should be
considered for treatment of LTBI if their reaction to the Mantoux
tuberculin skin test is ≥10 mm:
- Recent arrivals (> 5 years) from high-prevalence countries
- Injection drug users
- Residents and employees of high-risk congregate settings (e.g.,
correctional facilities, nursing homes, homeless shelters, hospitals,
and other health care facilities)
- Mycobacteriology laboratory personnel
- Persons with clinical conditions that make them high-risk
- Children under 4 years of age, or children and adolescents exposed
to adults in high-risk categories
Persons with no known risk factors for TB may be considered for
treatment of LTBI if their reaction to the tuberculin test is ≥
15 mm. However, targeted skin testing programs should only be conducted
among high-risk groups. All testing activities should be accompanied
by a plan for follow-up care for persons with TB infection or disease.
Regimens
For persons suspected of having LTBI, treatment should not begin
until active TB disease has been excluded. Persons suspected of
having TB disease should receive the recommended multidrug regimen
for treatment of disease until the diagnosis is confirmed or ruled
out.
Although regimens are broadly applicable, there are modifications
that should be considered under special circumstances (i.e., HIV
infection, suspected drug resistance, pregnancy, or treatment of
children). Listed in the table are the regimens; please refer to
Targeted Tuberculin Testing and Treatment of Latent TB Infection1
for detailed information for the treatment of LTBI.
Due to the reports of severe liver injury and deaths, CDC now recommends
that the combination of rifampin (RIF) and pyrazinamide (PZA) should
generally not be offered for the treatment of LTBI. If the
potential benefits significantly outweigh the demonstrated risk
of severe liver injury and death associated with this regimen and
the patient has no contraindications, a TB/LTBI expert should be
consulted prior to the use of this regimen.2 (Clinicians
should continue the appropriate use of RIF and PZA in multidrug
regimens for the treatment of active TB disease.3)
Table: Drug Regimens for the Treatment of LTBI
Drugs |
Duration (months) |
Interval |
Minimum doses |
Isoniazid |
9 |
Daily |
270 |
Twice weekly |
76 |
Isoniazid |
6 |
Daily |
180 |
Twice weekly |
52 |
Rifampin |
4 |
Daily |
120 |
Rifampin/Pyrazinamide |
Generally should not be offered for treatment
of LTBI2 |
Monitoring
Isoniazid or Rifampin Alone
Routine laboratory monitoring during treatment of LTBI is
indicated only for those whose baseline tests suggest a liver
disorder and for other persons with a risk of hepatic disease.
Laboratory testing should be performed to evaluate possible adverse
reactions that occur during the treatment regimen.
Rifampin/Pyrazinamide or Rifabutin/Pyrazinamide
A TB/LTBI expert should be consulted prior to the use of this
regimen.
CDC is collecting reports of all severe adverse events (e.g., liver
injury, metabolic acidosis, anaphylaxis, seizure, severe dermatitis)
leading to hospitalization or death of a person receiving treatment
of latent tuberculosis infection that occurred after January 1,
2004. Report these adverse events to the Division of Tuberculosis
Elimination at 404-639-8401 or LManangan@cdc.gov.
Additional Information
- ATS/CDC. Targeted
tuberculin testing and treatment of latent TB infection.(PDF)
MMWR 2000;49(No. RR- 6).
- 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.(PDF) MMWR 2003;49 (No. RR-11).
-
CDC. Multidrug-Resistant Tuberculosis (MDR
TB). - CDC. Extensively Drug-Resistant
Tuberculosis (XDR TB).
Last Modified: 06/24/2008
Last Reviewed: 05/18/2008 Content Source: Division of Tuberculosis Elimination
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
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