Active tuberculosis (TB) develops in 5-10% of individuals who become infected with M. tuberculosis, typically after a latency period of 6-18 months (but sometimes decades later). Compliance with the 9 month self-supervised isoniazid (INH) regimen has been porr with completion rates <60%. Until recently, daily rifampin for 4-6 months has been the only alternative when the bacterium is resistant or INH cannot be used.
Pertinent Study Design and Conclusions:
Another rifamycin class antibiotic, Rifapentine (RPT) is approved for MDR-TB but had not been approved for latent TB treatment.
Recent RCTs show 12 weekly doses of INH-RPT administered as directly observed therapy (DOT) are efficacious in preventing active disease and are better tolerated.
CDC now recommends the 12 week INH-RPT DOT regimen as an equal alternative to 9 months of self supervised daily INH in patients aged >12 years who have a high likelihood of developing active TB.
Bottom LIne:
A substantially shorter course of therapy with INH-RPT is now the recommended treatment for latent TB.
University of Maryland Section of Global Emergency Health
Author: Emilie J. B. Calvello, MD, MPH
References
MMWR Morb Mortal Wkly Rep. 2011 Dec 9;60(48):1650-3.
