Treatment Regimens for Latent TB Infection (LTBI)

There are several treatment regimens recommended in the United States for latent TB infection. The medications used to treat latent TB infection include the following:

  • Isoniazid (INH)
  • Rifapentine (RPT)
  • Rifampin (RIF)

These medications are used on their own or in combination, as shown in the table below.

CDC and the National Tuberculosis Controllers Association (NTCA) preferentially recommend short-course, rifamycin-based, 3- or 4-month latent TB infection treatment regimens over 6- or 9-month isoniazid monotherapy. Short course regimens include:

Short-course treatment regimens, like 3HP and 4R, are effective, safe, and have higher completion rates than longer 6 to 9 months of isoniazid monotherapy (6H/9H). Shorter, rifamycin-based treatment regimens generally have a lower risk of hepatotoxicity than 6H and 9H.

If short-course treatment regimens are not a feasible or an available option, 6H and 9H are alternative, effective latent TB infection treatment regimens. Although effective, 6H and 9H have higher toxicity risk and lower treatment completion rates than most short-term treatment regimens.

All treatment must be modified if the patient is a contact of an individual with drug-resistant TB disease. Clinicians should choose the appropriate treatment regimen based on drug susceptibility results of the presumed source case (if known), coexisting medical conditions (e.g., HIVexternal icon), and potential for drug-drug interactions. Consultation with a TB expert is advised if the known source of TB infection has drug-resistant TB.

Read Guidelines for the Treatment of Latent Tuberculosis Infection: Recommendations from the National Tuberculosis Controllers Association and CDC, 2020 to learn more about treatment regimens for latent TB infection.

Read Update of Recommendations for Use of Once-Weekly Isoniazid-Rifapentine Regimen to Treat Latent Mycobacterium tuberculosis Infection for more information about the 3HP treatment regimen.

Latent TB Infection Treatment Regimens

Latent TB Infection Treatment Regimens
Drug(s) Duration Dose Frequency Total Doses
Isoniazid (INH)* and Rifapentine (RPT) 3 months Adults and Children aged 12 years and older:
INH: 15 mg/kg rounded up to the nearest 50 or 100 mg; 900 mg maximum
RPT:
10–14.0 kg 300 mg
14.1–25.0 kg 450 mg
25.1–32.0 kg 600 mg
32.1–49.9 kg 750 mg
≥50.0 kg 900 mg maximum
Children aged 2–11 years:
INH*: 25 mg/kg; 900 mg maximum
RPT: as above
Once weekly 12
Rifampin (RIF)§ 4 months Adults: 10 mg/kg

Children: 15–20 mg/kg
Maximum dose: 600 mg

Daily 120
Isoniazid (INH)* and Rifampin)§ 3 months Adults:

INH*: 5 mg/kg; 300 mg maximum

RIF§: 10 mg/kg; 600 mg maximum

Children:

INH*: 10-20 mg/kg; 300 mg maximum

RIF§: 15-20 mg/kg; 600 mg maximum

Daily 90
Isoniazid (INH) 6 months Adults: 5 mg/kg
Children: 10–20 mg/kg
Maximum dose: 300 mg
Daily 180
Adults:15 mg/kg

Children: 20–40 mg/kg

Maximum dose: 900 mg

Twice weekly 52
9 months Adults: 5 mg/kg

Children: 10–20 mg/kg

Maximum dose: 300 mg

Daily 270
Adults: 15 mg/kg

Children: 20–40 mg/kg

Maximum dose: 900 mg

Twice weekly 76

*Isoniazid (INH) is formulated as 100 mg and 300 mg tablets.
Rifapentine (RPT) is formulated as 150 mg tablets in blister packs that should be kept sealed until use.
Intermittent regimens must be provided via directly observed therapy (DOT), that is, a health care worker observes the ingestion of medication.
§Rifampin (rifampicin; RIF) is formulated as 150 mg and 300 mg capsules.
The American Academy of Pediatrics acknowledges that some experts use RIF at 20–30 mg/kg for the daily regimen when prescribing for infants and toddlers (American Academy of Pediatrics. Tuberculosis. In: Kimberlin DW, Brady MT, Jackson MA, Long SS, eds. Red Book: 2018 Report of the Committee on Infectious Diseases. 31st ed. Itasca, IL: American Academy of Pediatrics; 2018:829–853).
The American Academy of Pediatrics recommends an INH dosage of 10–15 mg/kg for the daily regimen and 20–30 mg/kg for the twice weekly regimen.

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