Current management options for latent tuberculosis: a review

Figures & data

Table 1 Regimens and doses for treatment of latent tuberculosis infection – guidelines from the Centers for Disease Control and Prevention^67,75

Regimen	Dose	Frequency/duration	Comments
Isoniazid
Adults	5 mg/kg (max 300 mg)	Daily × 9 months	Preferred regimen
Children	10–20 mg/kg (max 300 mg)
Adults	15 mg/kg (max 900 mg)	Twice weekly × 9 months	Directly observed only
Children	20 mg/kg (max 900 mg)
Adults	5 mg/kg (max 300 mg)	Daily × 6 months	Not appropriate for HIV-infected individuals or children
	15 mg/kg (max 900 mg)	Twice weekly × 6 months
Rifampin
Adults	10 mg/kg (max 600 mg)	Daily × 4 months
Children	10–20 mg/kg (max 600 mg)	Daily × 6 months
Rifapentine/isoniazid
Adults	Isoniazid	Once weekly × 3 months (12 doses)	Directly observed only
	15 mg/kg (max 900 mg) plus
	Rifapentine
	10.0–14.0 kg: 300 mg
	14.1–25.0 kg: 450 mg
	25.1–32.0 kg: 600 mg
	32.1–49.9 kg: 750 mg
	>50 kg: 900 mg

Abbreviation: HIV, human immunodeficiency virus.

Table 2 Criteria for determining tuberculin skin test positivity⁷⁶

Presumptive treatment	≥5 mm induration	≥10 mm induration	≥15 mm induration
HIV-positive or immunosuppressed patients with recent contact with active TB case patients Children under the age of 5 years with recent contact with active TB case patients^a	HIV-positive persons Recent contact with active TB case patients Fibrotic changes on chest radiograph consistent with prior TB Patients with organ transplants and other immunosuppressed patients (receiving the equivalent of 15 mg/d of prednisone for 1 month or more)	Persons with the following clinical conditions: silicosis; diabetes mellitus; chronic renal failure; leukemia; lymphoma; carcinoma of the head or neck; lung cancer; weight loss of 10% of ideal body weight; gastrectomy; and jejunoileal bypass Children younger than 4 years of age Infants, children, and adolescents exposed to high-risk adults Recent immigrants (ie, within the last 5 years) from high-prevalence countries Residents and employees of the following high-risk congregate settings: prisons and jails; nursing homes and other long-term facilities for the elderly; hospitals and other health care facilities; residential facilities for patients with AIDS; and homeless shelters Mycobacteriology laboratory personnel	Persons with no known risk factors for TB

Notes:

a Children under the age of 5 years who have had contact with an active TB case patient should receive a tuberculin skin test (TST) and a chest radiograph; if there is no evidence of active TB, they should receive window prophylaxis until the result of their second TST is known 8–12 weeks later. If both tests are negative, window prophylaxis can be stopped; otherwise, a full course of LTBI treatment should be given.

Abbreviations: HIV, human immunodeficiency virus; TB, tuberculosis; LTBI, latent tuberculosis infection; AIDS, acquired immunodeficiency syndrome.

Centers for Disease Control and Prevention (CDC)Recommendations for use of an isoniazid-rifapentine regimen with direct observation to treat latent Mycobacterium tuberculosis infectionMMWR Morb Mortal Wkly Rep201160481650165322157884

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Centers for Disease Control and PreventionLatent Tuberculosis Infection: A Guide for Primary Health Care Providers Available from: http://www.cdc.gov/tb/publications/ltbi/treatment.htm. Accessed November 13, 2012.

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Centers for Disease Control and PreventionLatent Tuberculosis Infection: A Guide for Primary Health Care Providers Available from: http://www.cdc.gov/tb/publications/ltbi/diagnosis.htm. Accessed November 13, 2012.

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