Treatment of latent TB infection is essential to controlling and eliminating TB in the United States because it substantially reduces the risk that latent TB infection will progress to TB disease. Up to 13 million people in the United States have latent TB infection. Without treatment, they are at risk for developing TB disease in the future. Treatment greatly reduces this risk.
Several treatment regimens are available for the treatment of latent TB infection. These regimens are equally effective; however, clinicians should prescribe the more convenient shorter regimens, when possible. Patients are more likely to complete shorter treatment regimens.
Updated Recommendations for the 12-dose Latent TB Infection Treatment Regimen
The shortest of the available regimens to treat latent TB infection combines two medicines isoniazid and rifapentine, and is taken once-weekly for 12 weeks. CDC has recently released updated recommendations to support expanded use of this effective, shorter, treatment regimen to reach even more people with latent TB infection.
Clinicians can now prescribe the 12-dose regimen to patients as self-administered therapy, meaning patients can take medicines themselves. Previously, the 12-dose treatment regimen had to be administered by directly observed therapy (DOT), meaning a health worker had to observe each dose. Self-administered therapy can be more convenient for patients and clinicians.
The updated recommendations are also good news for two groups who have a higher risk of developing TB disease once infected: children and people with HIV/AIDS. In addition to continuing to recommend the regimen for people age 12 and older, CDC now recommends the 12-dose regimen for children and adolescents age 2-11, and people with HIV/AIDS who are taking antiretroviral medications with acceptable drug interactions with rifapentine.
The updated recommendations contain guidance for clinicians on patient education and monitoring. It is important that clinicians educate patients about possible adverse events, and instruct patients to use a symptom checklist and medication intake log.[155 KB] Clinicians should also follow CDC guidance on early detection and management of adverse events.
What Clinicians Can Do
Clinicians can work with patients to determine the best latent TB infection treatment regimen, prescribe shorter regimens, and provide support and resources to help patients to complete treatment successfully. CDC has patient education resources, as well as information for clinicians to help answer questions about the 12-dose regimen. CDC’s latent TB infection resource hub, state and local TB programs, and the TB Centers of Excellence for Training, Education, and Medical Consultation are also excellent sources for more information about treating latent TB infection.
The United States has made great progress towards the goal of TB elimination, but we can increase our prevention efforts to turn TB elimination into a reality. Our public health system and private providers play a crucial role in this effort to expand testing and treatment for latent TB infection, especially within high-risk communities.