The National Tuberculosis Controllers Association (NTCA) and the Centers for Disease Control and Prevention (CDC) have released updated guidelines for the treatment of latent tuberculosis (TB) infection, which were published in the MMWR Recommendations and Reports.
A committee of experts in epidemiology, domestic and international TB control, clinical trials, and treatment of latent TB in adults and children developed the guidelines based on a systematic literature review. The last set of comprehensive guidelines was published in 2000, and since then several new regimens have been assessed in clinical trials.
The committee’s review was performed to identify which regimens for latent TB infection have the greatest efficacy and least toxicity. The quality of evidence was assessed by using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria.
In this updated guideline, the committee recommended a 3-month regimen of weekly isoniazid plus rifapentine in adults and children aged >2 years. This recommendation was based on moderate evidence and given a strong GRADE rating, suggesting that the committee determined that the benefits outweigh any potential negative effects.
In addition, the committee recommended 4 months of daily rifampin for adults without HIV and in children of all ages, a regimen that is similar in efficacy and less toxic than 9 months of daily isoniazid. This recommendation is also based on moderate evidence and was given a strong GRADE recommendation rating.
Another strong GRADE recommended regimen for the treatment of latent TB infection in adults without HIV is 6 months of daily isoniazid, which was also based on moderate evidence. In adults with HIV, the recommendation was given a conditional GRADE recommendation, which suggests that there may be some uncertainty surrounding the weight of the regimen’s desirable benefits compared with undesirable effects in this population.
Limitations of the guideline included the lack of examination of cost-effectiveness of the regimens, as well as the lack of assessment of how these regimens can be implemented programmatically (eg, who to test and treat and side effect management).
The committee wrote that the recommendations “can be used by clinicians, public health officials, policymakers, health care organizations, and other state and local stakeholders who might need to adapt these guidelines for individual clinical circumstances.”
Sterling TR, Njie G, Zenner D, et al. Guidelines for the treatment of latent tuberculosis infection: recommendations from the National Tuberculosis Controllers Association and CDC, 2020. MMWR Recomm Rep. 2020;69(1):1-11.