The U.S. Centers for Disease Control and Prevention (CDC) and the National Tuberculosis Controllers Association (NTCA) published "Guidelines for the Treatment of Latent Tuberculosis Infection" in CDC’s Morbidity and Mortality Weekly Report Recommendations and Reports. This is the first comprehensive update to U.S. latent tuberculosis infection treatment (LTBI) guidelines since 2000. CDC and NTCA preferentially recommend short-course, rifamycin-based, 3- or 4-month LTBI treatment regimens over 6- or 9-month isoniazid monotherapy. 

Treatment of LTBI is essential to controlling and eliminating tuberculosis (TB) in the United States because it substantially reduces the risk that LTBI will progress to TB disease. Up to 13 million people in the United States have LTBI. Without treatment, they are at risk for developing TB disease in the future; however, treatment greatly reduces this risk. 

Highlights from the new guidelines include:

• To treat latent TB infection, CDC and NTCA preferentially recommend:
  • Three months of once-weekly isoniazid plus rifapentine (3HP). 3HP is strongly recommended for adults and children older than 2 years, including HIV-positive persons.
  • Four months of daily rifampin (4R). 4R is strongly recommended for HIV-negative adults and children of all ages.
• Three months of daily isoniazid plus rifampin (3HR) is conditionally recommended for adults and children of all ages and for HIV-positive persons. 
• If short-course treatment is not a feasible or available option (e.g., due to drug interactions with rifamycins), CDC and NTCA recommend six or nine months of daily isoniazid (6H/9H) as alternative, effective latent TB infection treatment regimens.
• More than 80% of people who develop TB disease in the United States each year get sick from longstanding, untreated latent TB infection. Short-course latent TB infection treatment regimens are effective, safe, have a lower risk of hepatotoxicity, and have higher completion rates than longer 6 to 9 months of isoniazid monotherapy. The availability of short-course regimens can also enable providers to treat larger numbers of people who are at risk for TB disease.

Public health and private providers play a crucial role in expanding the testing and treatment of LTBI. Clinicians can work with patients to determine the best LTBI, prescribe shorter regimens, and provide support and resources to help patients complete LTBI treatment successfully. 

ODH has information regarding LTBI for consumers and for professionals. Additionally, CDC has resources and tools for LTBI for health care providers, public health professionals, and patients.