CDC | TB | Treatment for Latent TB Infection (LTBI)

Tuberculosis

Treatment for Latent TB Infection

Treatment of latent TB Infection greatly reduces the risk that TB infection will progress to TB disease. Certain groups are at very high risk of developing TB disease once infected. Every effort should be made to begin appropriate treatment and to ensure completion of the entire course of treatment for latent TB infection.

Treatment Regimens for Latent Tuberculosis Infection

Treatment of latent TB infection should be initiated after the possibility of TB disease has been excluded. Once the diagnosis of latent TB infection has been made, health care providers must choose the most appropriate and effective treatment regimen.

The four treatment regimens use isoniazid (INH), rifapentine (RPT), or rifampin (RIF). Treatment must be modified if the patient is a contact of an individual with drug-resistant TB. Consultation with a TB expert is advised if the known source of TB infection has drug-resistant TB.

Table 1. Latent TB Infection Treatment Regimens

Drugs	Duration	Interval	Minimum doses
Isoniazid	9 months	Daily	270
Isoniazid	9 months	Twice weekly*	76
Isoniazid	6 months	Daily	180
Isoniazid	6 months	Twice weekly*	52
Isoniazid and Rifapentine	3 months	Once weekly*	12
Rifampin	4 months	Daily	120

*Use Directly Observed Therapy (DOT)

Note: Due to the reports of severe liver injury and deaths, CDC recommends that the combination of rifampin (RIF) and pyrazinamide (PZA) should generally not be offered for the treatment of latent TB infection.

Although regimens are broadly applicable, there are modifications that should be considered under special circumstances (e.g., HIV infection, suspected drug resistance, pregnancy, or treatment of children). Table 1 lists the current recommended regimens. Refer to Targeted Tuberculin Testing and Treatment of Latent TB Infection and Recommendations for Use of an Isoniazid–Rifapentine Regimen with Direct Observation to Treat Latent Mycobacterium tuberculosis Infection. for detailed information about the treatment of latent TB infection.